3 Questions to Ask When Processing Medical Billing Claims
By - Claims management – the art of consolidating, billing, filing, revising, and managing medical claims – is an imperative aspect of the healthcare industry. Medical facilities cannot receive due funds if patients are unaware or confused about how much they need to pay. The claims process itself is multifaceted and arduous with many hospitals opting to outsource their claims management needs, as the journey from point A from point B is often far from simple.
As RevCycleIntelligence.com reported, 1 in 3 complaints from patients to healthcare practices is directly related to billing issues. Reducing uncertainty and making sure claims are scrubbed before patients walk out the door are key to ensuring a high probability of diligently clean and accurate claims management.
Smaller clinical settings face more pronounced claims management hindrances, as EHRIntelligence.com confirms. One hiccup is that although physicians are more aligned with the role of caregivers than businessman, they often lack the knowledge needed to manage their practice from a business perspective. Some argue such a skillset is vital to be successful within the claims management realm and best analyze loss.
Nonetheless, high denial rates are one of many signs a payer is not in the best position to embrace additional elements of risk or experiment openly in innovative growth areas, as RevCycleIntelligence.com reported. It is the responsibility of a designated payer, generally a health insurance company, to evaluate a claim and determine which services will be reimbursed.
Here are selected highlights of three top questions payers should consider addressing while processing medical billing claims:
How can we enhance technological consistency?
A variety of tools exist to scrub claims efficiently by checking for document errors, utilizing automatic software that reduces unreadable information, or assist healthcare providers electronically enter information. Unfortunately, they often lack accuracy and require a set of human eyes to ensure correctly entered information. As mainstreamed technology becomes more readily available and cost efficient, perhaps levels of accuracy via technological methods will improve.
How can manual claims errors be reduced?
On the opposite end of the technology spectrum lies the ever familiar pen and paper. Payers receive paper claims that are essentially completed by hand and sent out via mail. The processing of paper claims clearly requires more manual effort and, therefore, a greater likelihood of erroneously entered information. A handwritten code that is illegible, a document mailed to the wrong address, lack of sufficient postage, etc. are costly errors for a healthcare provider, generally resulting in the delay of payment. A claim may be rejected if patient or health insurance information is not correctly entered.
Where is the next best overall focus?
What’s your greatest weakness? It is important to candidly answer this question. For instance, consider that healthcare payers experience the largest financial burden with regard to outpatient spending, as HealthITAnalytics.com confirms.
Payers should ask themselves key questions about their ICD-10 readiness levels, as well, especially as the deadline looms closer than ever before.
Overall, payers must consider individuals as both consumers and patients, as EHRIntelligence.com reported. Perhaps considering a more humanistic approach to healthcare is another imperative key to ongoing payer success – be respectful of varying degrees of healthcare literacy, social technology knowledge, and general cultural or demographic concerns to best communicate.
