5 Ways to Improve Medical Claims Management
Posted by Janna Vienca Cañezal
Medical claims management is only one part of your entire revenue cycle process, yet having an inefficient medical claims process affects the overall financial health of your practice. Even though patient payments make up a significant part of a practice’s income, managing claims and reducing denials is still essential in receiving full payment for services rendered.
According to the Centers for Medicare & Medicaid Services (CMS), around 30% of claims are denied or ignored upon initial submission. Even the most minor coding error can cause payment delays, or worse, a claim denial. When a payer denies a claim, you waste the time and resources you used to process it. Inefficiencies in your claims management process affect your cash flow and negatively impact the patient experience. Improving your claims management system is a vital step towards a successful business and satisfied patients.
How Can Practices Improve Medical Claims Management?
The goal of every practice is to shorten the billing cycle and collect payments quickly. However, the medical billing process is complex, taking several days to months before a provider receives compensation. Changing reimbursement policies, patient expectations, and healthcare’s shift to value-based care add further complications. Thankfully, there are steps your practice can take to improve claims management, reduce rejections, and get paid faster.
1. Regularly Update Information
A patient you saw a couple of months ago may have changed jobs and gotten a different insurance carrier and coverage. If your billing team submits that claim without verifying a patient’s eligibility, you risk rejection. Your staff then needs to repeat the whole process instead of moving on to new claims.
Inaccurate information leads to erroneous claims. Regularly updating patient demographics and insurance information every time a patient comes in for an appointment helps your practice consistently submit clean claims. Train your front desk to ask patients to update their details during check-in. To prevent patients from crowding the front desk, allow your patients to update their records before the appointment through an online portal. You can also add a self-check-in app that enables patients to update their records at arrival. By utilizing technology for patient verification, you’ll avoid inaccurate information due to poor ineligible handwriting or misheard information.
2. Automate Repetitive Tasks
Claims processing is a tedious and repetitive process. However, you can use automation to simplify the process and increase billing efficiency. Identify routine tasks in the claims process and use practice management software to support those tasks. Save time by automating real-time eligibility verification, superbill creation, and insurance payment posting. Furthermore, some EHRs have auto-suggestion features that providers can use when adding diagnosis codes.
Automating your billing functions reduces human errors, prevents claim rejections, and expedites the billing cycle.
3. Invest in Staff Training
Practices work with a lot of different payers, and each payer follows a different set of rules. For inexperienced billers, processing each claim can be confusing and might lead to errors. Refresher training helps your staff remember each payer’s requirements when submitting claims.
Most of the time, a claim’s rejection message is hard to dissect. Teach your billers to be problem solvers. Learning how to analyze rejections takes time, experience, and training. Preparation helps your staff process claims with fewer errors and eventually streamline the claim management process.
A healthy revenue cycle doesn’t solely depend on your billing team. Conduct training for front desk staff and providers on best practices for capturing patient information and providing quality clinical documentation.
4. Stay Educated
Medical claims billing changes constantly. The American Medical Association (AMA) publishes a new set of codes every year. CPT codes are added, revised, and deleted annually to adapt to changes in the healthcare industry. Knowledge of the yearly changes is vital in preventing medical coding errors and claim denials. AMA holds annual events and releases a yearly CPT Professional coding book for practices to stay up to date with the current CPT code changes.
Public and private payers also constantly change their policies to accommodate healthcare regulations. Encourage your billers to review fees and contracts with payers regularly. Maintain good relationships with your insurance carriers so that you’ll be the first to know of any changes. Stay up to date on the latest healthcare laws and federal and state regulations by subscribing to reliable healthcare news outlets. Partner with EHR software companies that provide you with healthcare insights and industry trends. Keeping up with healthcare changes helps improve claims management and increases your overall revenue.
Read More: How to Navigate 2021’s E&M Coding Changes
5. Track Claims Rejections and Denials
Resubmitting rejected and denied claims require a lot of time and resources and drain your staff’s productivity. Additionally, if the deadline to send the corrected claim has passed, the payer can deny the claim again. The result is an unpaid claim that both practices and patients want to avoid. It affects your cash flow and damages your relationship with the patient.
Denials and rejections are opportunities to see gaps in your billing process. Investigate what’s causing them and address those issues. For example, suppose you receive a rejected claim because of clerical errors, such as a misspelled name or incorrect member ID. In that case, you might want to streamline your patient registration and eligibility verification process to ensure correct data. If your claims come back as denied due to incorrect diagnoses and CPT codes, you might want to improve communication lines between your billers and providers. While these errors can be corrected, they still prolong the revenue cycle.
Learn from your claim denial and rejections and use them to increase your clean claim rates.
An All-in-One EHR for All Your Billing Needs
Inefficiencies in the medical industry are also prevalent in non-clinical processes. Healthcare practices lose billions of dollars annually due to inefficiencies in the revenue cycle process alone. With the challenges the healthcare industry faced during the pandemic, it’s more important than ever to secure every dollar you deserve. Partnering with an EHR software company that supports every aspect of your billing process can go a long way.
Meditab’s all-in-one EHR, IMS, covers your entire revenue cycle from patient registration to collecting patient payments. With an integrated billing system, practices can seamlessly pull up data needed to process a claim on the same platform, saving your staff time and reducing coding errors.
Our billing implementation team understands your billing workflow and tailors implementation accordingly. To ensure timely filing of rejection, denials, and other concerns, we’ve created a dedicated billing support team to make sure we give you the prompt attention you deserve. More than just an EHR, IMS is a partner that sets you up for success.