The Undeniable Value of Effective Claims Management

Tips to proactively clean up claims for accelerated third-party payments

There’s no denying the negative impact denied claims have on the revenue cycle of hospitals and health systems of all shapes and sizes. Denied claims not only inhibit final acquisition payment, they deplete valuable time, labor and resources put forth by staff members responsible for handling and tracking those claims. It’s not implausible for providers to lose literally millions of dollars in denied or underpaid claims over the course of a year.

As burgeoning costs and tightened reigns on spending come into play, the bottom line is at the forefront unlike ever before. Providers are keenly aware that clean claims processing is the priority of prompt third-party revenue generation and an immensely important cost cutting measure, but what are some other practical tactics that can be used to ensure larger, more complete payment? Here are some effective methods for claims management:

• Conduct claims reviews- When denials occur, it’s essential to assess what went wrong in order to remedy issues in the future. By conducting examinations of erroneous claims, providers can pinpoint problematic patterns and respond with solutions. In tandem, such reviews allow for identification of correct parties for handling specific issues leading to even more honed opportunities to avoid future denials. Culling thorough information of denied claims should also entail the assignment of dollar values to those losses so that the entire organization may fully grasp the imperative nature of clean claims submission.

• Train before the denial occurs- Engraining a culture of awareness may help clean up claims submitted and minimize claim denial occurrences. There is a short list of highly common reasons claims are rejected, including questions about beneficiary coverage and coverage of services rendered to problems with duplicate billing and an array of procedure code inconsistencies. Of course, some issues may be specific to providers or systems. Pre-knowledge of these denial triggers can help staff take measures for prevention.

• Create a cross-functional team to address claims issues- Certainly, it’s of great help to integrate best practices throughout a providers’ entire operations. The creation of an assigned team to tackle claims denials is a large step beyond the aforementioned training. However, a responsible team can take issue identification and staff training to more targeted, purposeful levels. From ensuring frontline staff ask the right questions at Patient Access and financial representatives follow stringent procedures for claims adjudication post-care, providers may find their claims more frequently accepted, effectively tracked and fully reimbursed. Built in mechanisms for reporting and tracking success will also aid in effectiveness of this approach.

• Invest in automation- The reality is, provider team members are often woefully busy. With the ever changing details regarding benefits and eligibility, it’s nearly impossible to keep everyone on staff thoroughly and appropriately apprised in order to ensure clean claims submissions, let alone updates systems with standard codes and payer edits. The investment in automation is most certainly a transformative and valuable one.

Using these four tips to proactively manage claims correctly will not only lead to effective claims management, but you’ll also have less to write off in the end. Those are two benefits with undeniable advantages every provider needs today.

Are you ready for effective claims management and accelerated third-party payments? Visit us online or call 877.EMDEON.6 (877.969.9666) to discover more about how Emdeon can transform your claims management processes to positively impact your bottom line.

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