Poor claims management and failure to stay up to date on the latest rules and regulations can cost your organization uncollected revenue, lost time through coding errors, and the need to resubmit faulty claims. In fact, the cost of denials soared 67% in 2022.1 How can you improve medical billing? By implementing seven simple strategies you can enhance your claims management and dramatically improve your revenue.
This blog covers simple strategies that show you how to improve medical billing processes, including:
- Collecting accurate patient data
- Improving first-pass yield
- Ensuring clean claims submissions
- Minimizing coding errors
- Promptly handling rejected and denied claims
- Updating your claims management software
- Tracking payer trends and financial performance
1. Ensure patient data is collected accurately
A large percentage of claims denials can be attributed to patient registration issues.2 So it’s crucial that staff have the right tools to ensure accurate patient data is collected at the forefront of care. Some software applications empower staff to validate patient identity, verify eligibility, and identify all available insurance coverage – all within a few steps powered by a single patient registration application. This helps reduce downstream denials and reimbursem*nt delays through accurate patient data collection at intake.
2. Improve number of claims paid upon first submission; first-pass yield
Perhaps one of the most important ways to improve medical billing processes is to optimize your first-pass yield. Prioritizing first-pass yield decreases the number of denied claims and reduces the time and labor spent on fixing rejected claims. The latest software applications allow you to easily measure your first-pass yield rate by providing at-a-glance indications of denial percentages and claim corrections.
3. Focus on your clean claims rates
Medical bills commonly contain incorrect information – from erroneous patient or insurance data, to duplicate billings, to missing or unclear denial codes. You can almost guarantee that payers are going to reject erroneous claims, require them to be updated, and resubmitted. Identifying errors before claims submission is the biggest claims management challenge for 48% of providers in a recent survey.3
Not only does this require more man-hours to fix but it can dramatically extend the time before a provider receives payment for their healthcare services. According to the American Health Information Management Association, as many as 60% of returned claims are never resubmitted.4 It is often helpful to contact the payer directly to identify and fix these errors especially if an explanation of benefits (EOB) was never included with a denied claim.
A better focus on workflow analytics can help providers understand what is causing a low clean claims rate. Claims management software often contains up-to-date CMS and commercial payer rulesets and can be optimized for your organization to help increase your proportion of clean claims.
4. Improve medical billing by minimizing coding errors
Some of the most common coding errors are non-specific diagnosis codes and incorrect modifiers. At times, diagnosis codes can be considered insufficient because the physician never documented it. This can be improved by capturing more accurate data from the referring physician.
Incorrect modifiers are often determined by the payer, but ensuring that you’ve applied the proper modifiers can help your organization capture full reimbursem*nt instead of a denied claim. Finally, upcoding or undercoding can cause claims to be filed with codes for more or less expensive procedures. It’s worth double-checking these codes before submitting the claim.
5. Prioritize rejected and denied claims
Processing rejected and denied claims promptly is a key part of handling claims efficiently. A rejected claim can be resubmitted quickly, but a denied claim can take longer to process because it must first be appealed before resubmitting. While maintaining a close relationship with the payer is important so that you can resubmit these issues promptly, the latest software can often identify the reason a claim was denied so it can be adjusted appropriately. The most common reasons for denial are: incomplete or inaccurate patient information; healthcare plan changes; claims submission errors; and untimely claims submissions.
6. Consider upgrading your claims management software
In today’s healthcare environment, one key piece of improving your medical billing process is the technology your office uses. Is the software outdated and clumsy to use? Or is it leading-edge, user-friendly, and designed specifically for the task at hand? Some applications allow staff to manage the medical billing process and all payers – whether Medicare or commercial – from a single dashboard, dramatically reducing stress and cutting the time required to submit a claim.
In addition, some of the better software applications can save time by automatically verifying eligibility, dramatically increasing your clean claims rate, and reducing denials and payer rejections. Having the right software ensures your staff can see the full claims management picture and enables a much more efficient workflow. For example, a single-sign-on claims management application turns the traditional process of logging in and out of multiple systems into a smooth, intuitive process.
7. Track payer trends and financial performance
A key component of revenue cycle management is tracking financial performance in real time. Key performance indicators (KPIs) that should be monitored include payer scorecards and performance dashboards to track revenue cycle improvements, visualize where workflow challenges exist, and locate root causes by drilling down into specific claims. This knowledge also makes your claims management process more efficient by identifying problem accounts that are consistently late with payments, regularly declined, or have frequent changes in contact information.
How to improve medical billing performance with Inovalon
A lot can happen between providing the service and receiving payment. By employing these seven claims management strategies, you can take great strides toward improving your medical billing processes. This can provide benefits throughout your organization.
At Inovalon, we help healthcare providers do more for their patients and their bottom line through automation and analytics that enhance efficiency and claims accuracy.
Contact us today to learn how we can help improve your medical billing, revenue cycle management, care quality, and workforce management.
Sources:
1 “Hospital double whammy: Less cash in, more cash out,” Crowe RCA Benchmarking Analysis, Nov. 2022, https://www.crowe.com/-/media/crowe/llp/widen-media-files-folder/h/hospital-double-whammy-less-cash-in-more-cash-out-chc2305-001b.pdf?rev=91d36c682ee744b1ab4bcb56cb769bc1&hash=9A63564E3DBD39914F3674540158857E
2 “Claims Denials: A Step-by-Step Approach to Resolution,” Leigh Poland, RHIA, CCS and Srivalli Harihara CPC, PGPAIML, Journal of AHIMA, April 25, 2022, https://journal.ahima.org/page/claims-denials-a-step-by-step-approach-to-resolution
3 Inovalon claims management survey of healthcare providers, June 2021
4 “Claims Denials: A Step-by-Step Approach to Resolution,” Leigh Poland, RHIA, CCS and Srivalli Harihara CPC, PGPAIML, Journal of AHIMA, April 25, 2022, https://journal.ahima.org/page/claims-denials-a-step-by-step-approach-to-resolution
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