Revenue cycle management, or RCM, is an important aspect of any medical practice, yet it is not uncommon for your billing staff to read the phrase “CLAIM DENIED” on a daily basis. Over time, practices become accustomed to seeing these words on a screen and are complacent that this is an ongoing issue which cannot be resolved. However, tying up the loose ends of a claim can be costly.
A recent study by the American Medical Association found that medical practices spend nearly $15,000 on reworking claims, including phone calls, investigations, and claim appeals.
While medical billing is challenging, your practice can still implement strategies to increase reimbursement rates and reduce claim denials. Try utilizing these 8 techniques recommended by Revenue Cycle Intelligence the next time you evaluate your practice’s revenue cycle management.
1. Automate everything you can
Researching the latest insurance policies, updates, and different diagnostic codes can be a strenuous task. Your billing team should focus on timely matters such as double-checking and reworking claims. Select software solutions, such as RXNT’s Practice Management, include intuitive ICD-9 to ICD-10 mapping technology and a comprehensive database of ICD-10 and CPT codes. While practices can spend time flipping through pages of billing codes, using a vendor with technology to code to the exact degree of specificity reduces administrative work. Additionally, some vendors pull insurance information that is automatically updated in real time based on a patient’s demographics. These measures reduce research time and allow billing staff to focus on individual claims.
2. Stay on top of changes
Healthcare solutions can flag inaccurate claims and run aging reports. While this is a beneficial contribution to the billing process, the entire office should be aware of the general nature of Medicare regulations and other payers. Motivate your team members to subscribe to newsletters and to share relevant updates with everyone in your practice.
3. Do more up front
Revenue Cycle Insight reports that 15.5% of denied dollars result from registration processes; 8.5% and 7% are due to eligibility errors and pre-certification issues, respectively. Educate your staff on the importance of completing forms correctly and accurately. By investing time at the beginning, you will see results by minimizing minor claim mistakes.
4. Manage your team
When there are few measurements in place, it is difficult to know how efficient your billing team is. RXNT’s Practice Management has a dashboard that clearly displays an aging snapshot, including pending payments from patients and payers, and a charges snapshot, including provider charges and payments. It also runs comprehensive aging reports and tracks the percentage of reimbursement received per claim. Measuring your team’s success can be time-consuming, but software solutions can easily track key indicators and quantify performance.
5. Investigate causes of denials
Every time a claim is denied, the billing staff should see it as an opportunity for growth and improvement. Follow-up is essential for a healthy revenue cycle. Invest the time to understand the root cause and implement the change going forward.
6. Work denials daily
With numerous new claims filtering in daily, it is easy to forget the importance of reworking denied claims. Set goals and procedures for your team to process denied claims every day. Your billing staff should start by having a comprehensive list of denials. RXNT’s Practice Management has an alert section on the homepage that includes rejected claims. Once your billing staff is aware of the claims to target, your practice should prioritize them and set aside time each day to rework them.
7. Check your work
It can be overwhelming for individuals to track the success and failure of every claim. Even the smallest human error can lead to seeing the dreaded phrase, “CLAIM DENIED.” While your billing team should be hyper-vigilant when identifying claim errors before submission, software solutions streamline the process.
RXNT’s Practice Management tracks the status of a claim through its entire life cycle. Before a member of your billing team clicks “submit,” RXNT runs a pre-submission validation check. Once the claim is sent, it is thoroughly scrubbed. If there are any billing errors, the claim is returned to the practice before it even reaches the payer. Claims review is a critical yet time-consuming process that can be seamlessly managed with practice management solutions.
8. Do not miss deadlines
Although there are explainable reasons for claim denials, untimely filing should not be one. If a deadline is missed, you cannot retrieve the reimbursement, reducing your practice’s revenue. With RXNT’s Practice Management software, billing staff are directed to unbilled encounters and claims ready to be sent electronically. When using a healthcare software solution, 0% of your denial claims should be due to untimely filing.
Overall, physicians wish to provide their patients with the highest quality of care, yet there are undeniable obstacles surrounding medical billing. While practices can use these 8 tools to improve claim reimbursement, RXNT’s Practice Management automates the process. RXNT offers fully integrated EHR, Medical Billing, and E-Prescribing solutions that enable physicians to streamline their workflow.
