Don’t Let Unpaid Claims Slow You Down_Implement These Strategies to Plug Revenue Loss

Unpaid Claims

Do you want to be successful and gain a competitive edge? Then you must keep a close eye on all of your business aspects i.e patients’ care and financial management. Because both factors are crucial to long term survival as well as keep ahead of your competitors.

In this unpredictable era, constant revenue loss has become a major challenge for medical practitioners. Just like other businesses, the loss of hard-earned revenue sounds dreadful for the healthcare business too. Medical practitioners seem overwhelmed and frustrated when it comes to dealing with the denied insurance claims.

Healthcare providers lose thousands of dollars due to the high percentage of denied/rejected claims. The average claim denial rate in the healthcare industry is 5-10%.

So, in order to avoid critical financial crises such as: slow billing collections, cash flow disruption etc. Healthcare providers should implement smart medical billing solutions to keep their claims denial rate below 5%.

Here’s a question that arises: how can medical practitioners boost profitability by minimizing the claims denials? The answer is obvious. They should spend a considerable amount of time in analysing and improving their revenue cycle management. This process revolves around the healthcare providers, patients and insurance companies.

Healthcare revenue collections management is the financial process that involves the prior authorization of patients, patients’ registration, medical coding, charge entry, claims submission, payment posting, denial management, revenue collection etc.

No doubt it’s a complicated procedure but healthcare providers should never take it for granted. Because inefficient RCM process results in claim denials and high medical accounts receivables. That ultimately leads to the denied/partial payments and affects the financial well being of your medical business.

Causes of Revenue Leakage

As we have already discussed that the major reasons behind revenue leakage are the frequently denied claims. It occurs when payers deny the reimbursements for the healthcare services rendered.

So, in order to streamline your cash flow, you must have a complete understanding of the common factors behind claim denials. By analysing the denial trends, I have compiled a list of the most common reasons that could result in payment denials.

  • Incorrect/incomplete information: Medical claims containing incorrect information about patients’ demographics, healthcare providers and payers, get denied.
  • Wrong/Mismatched medical codes: Entering confusing ICD codes with CPT codes/. Or using medical codes for the most expensive or less expensive services than actually performed.
  • Duplicate billing: It occurs when your billing staff file a claim more than once for the same service provided to the patients at the same date.
  • Late filing of medical claims: Insurance companies have their own time window for claims submissions. They don’t accept the claims that are being filed after the deadline.

How Can You Prevent Revenue Loss?

It has been observed that some medical practices lack a focused strategy for denial management and medical billing services. That can result in an economic crisis and negatively impact your healthcare practice as a whole.

However, in order to keep your revenue cycle management optimized, physicians must apply the following techniques.

1. Implement an EHR System

Is your registration staff still relying on manual methods of information collection and keeping the patients’ records on papers? Then it could be major reasons for claim denials. Because using orthodox methods always leaves a huge room for human errors.

Therefore, medical practitioners should invest in automating the medical documentation process. Implementing an Electronic Health Records (RHR) system is the best solution to remove root causes of claim denials.

EHR solutions play a significant role in generating a positive return on investment and increasing the efficiency of your business. An EHR system can benefit you in the following ways:

  • Your billing staff can have easy and quick access to the patients’ records without wasting time in locating paper charts.
  • Make the information more accurate by eliminating the errors caused due to handwriting and legibility issues.
  • Prevents your highly confidential healthcare information from theft or misplacement,
  • Patients can access their medical details through patient portals.

In this way, medical practitioners can ensure accurate information flow throughout the revenue cycle management. Which reduces the chances of claims denials and results in maximum payment collection.

2. Manage the Medical Claims Efficiently

To get maximum reimbursements, healthcare providers must manage the medical claims in an effective manner. Because the consistent cash flow is highly dependent on the submission of clean medical claims.

The golden rule of thumb is to have well trained and experienced billers and coders in place. Because putting these responsibilities to the existing staff with zero to little knowledge has become a thing of the past.

The growing complexities of coding and billing demand a unique set of skills to handle medical billing services in an efficient manner. Therefore, it has become crucial to get the services of industry experts to file clean medical claims.

Moreover, healthcare practitioners should make sure that the insurance claims are being submitted with the following standards.

Use precise medical codes

Medical coding is considered as the lifeblood of a business. Because insurance agencies get the information about a particular injury,  diagnosis, treatments and medical services through these codes.

The wrong entry of medical codes holds insurance companies back from payments for a long time period. Therefore, you should hand over this responsibility to the certified medical coders.

Ensure timely submission of clean claims

It must be the core objective of medical billers to ensure the submission of clean medical claims. For this purpose, they should closely analyse each and every medical claim to catch the potential errors before submission.

Furthermore, they must understand the importance of ‘time’ in healthcare revenue collections management. Make sure that your billing staff is filing the claims on a regular basis.

The best thing you can do is use innovative billing software. Because automatic solutions can increase the efficiency and accuracy of medical claims drastically.

3. Implement Effective Denial Management Solutions

It is a fact that most of the denied claims remain unnoticed and unattended. As a result healthcare providers lose compensations permanently for the medical services that are provided to the patients.

Therefore, medical practitioners must have a claim denial management strategy in place. Which enables them to quickly identify, resolve and resubmit the claims on a priority basis. Because the longer you wait to appeal a rejected or denied claim,  it’s possible that you won’t get paid at all.

No doubt, reworking and appealing a denied claim is a time-consuming task.  In addition to this, healthcare providers find it difficult to manage the entire medical billing process. While providing the standard medical aid to the patients.

Furthermore, due to the mounting financial burden, they can’t maintain an in-house billing department.  In such circumstances outsourcing medical billing services come into the picture.

Outsourced medical billing specialists have unique coding and billing skills, required to keep your claims process optimized. They stay at the top of changes in the healthcare industry to manage your billing process as per industry standards.

Along with streamlining the cash flow of your business, they also eliminate the excessive administrative burden of the physicians. Eventually, healthcare providers can get sufficient time to spend in managing their medical obligations.

Medical Billing Benefits is an authentic source of information about the evolutions in the medical industry. It keeps you up-to-date with the billing and coding regulations, so you can keep your financial management optimized. For more information, subscribe to our Newsletter.

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