Staking Your Claim: Podcast Gives Practical Solutions for Overcoming Common Claims Management Challenges

For all too many hospitals and healthcare institutions, “claims management” is an oxymoron. Claims often elude management efforts amidst the layered, third-party payment structure of the industry. Government and commercial payers have varying rules and standards, while providers use disparate technology to process and transmit claims. Add to those incongruences the fact that healthcare charges are innately complex and detailed, and it’s clear why claims management is so, well, unclear.

In the business world, it’s often said “you can’t manage what you don’t measure.” By making a practical assessment of common challenges in claims management, hospitals can begin to better stake the claims as they come. With our vast payer and provider networks and literally hundreds of thousands of claims transmissions in process at any given time, Emdeon is keenly aware of claims management problems and have culled a representative list of common issues.

Do any of these scenarios sound familiar to you and your hospital staff?

- Lost in Transmission: Claims can easily get lost in transmission, especially when multiple vendors must interact with claims between provider and payer. The longer the journey, the more chance for a claim to get lost.
- A Catch in the Batch: An entire batch of claims may be rejected by a payer due to just a single error on a solitary claim. When this occurs, the payer will likely not provide explanation, leaving the provider to sift through the entire batch in search of the error.
- The Paper Chase: Paper claims continue to be used throughout the healthcare system. These hard copy claims require more manual effort, and, thus, are more susceptible to human error and/or loss within the system. Obviously, lost paper claims are very hard to find and track, offering little hope of recovery to meet timely filing requirements.
- Off-Track Tracking: Though electronic claims are much more easily tracked than paper ones, providers must put the mechanisms in place in order to infuse tracking into the process. This is a provider-driven priority that requires effort to put into action.
- Internal Differences: Health systems that are geographically diverse and large in scope often run on disparate billing procedures and technology, making it incredibly difficult to establish efficient protocols and coordinate claims management systemwide.

With a spotlight on these common challenges, we’re reminded of key tactics for effective claims management. For example, it’s essential to submit the cleanest claims possible, automate processes whenever circumstances (and budget) allow and infuse tracking throughout the system. Of course, advanced technology exists to improve overall claims management and identify internal patterns of problems that can then be addressed and eliminated. However, many providers do not yet have such solutions at their disposal. In those instances, proactive manual claim reviews, scrubbing and tracking (even if more people power is required) will make a far more positive impact than a reactive response after 30 or more AR days have accumulated.

No doubt, these things are definitely easier said than done. They require lots of strategy, organization-wide support and investment in resources. Listen Now at no charge to a recent HFMA podcast on “Strategies for Avoiding the Claims Black Hole to Accelerate and Maximize Payment” to hear more claims management tips and solutions. This podcast takes an in depth, practical look at this all-important topic. Through firsthand accounts of industry pros, this program gives insight into real-life, relatable struggles and offers ideas and solutions to overcome them.

To learn more about Emdeon Claims Management Solutions, visit us online or call 877.EMDEON.6 (877.363.3663) today!

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