Let’s assume that you have all of your ducks in a row when it comes to billing claims. You have assessed your procedures from the point of gathering patient demographics to the hiring of the most experienced coders. You’ve automated your workflow and implemented software to flag likely denials. You have done all that you can to expedite the claims process and streamline your accounts receivable (AR) management.
What’s at Stake?
Like it or not, however, a percentage of your claims will still be denied (an average of 9%). Although, according to Modern Healthcare, 60% of those initially denied claims will be paid. U.S. hospitals will still lose a total of $262 billion annually as a result of denied claims.
Whether you come up empty on a large or small unpaid claim, the result is the same: you will have to absorb the loss unless, by some good fortune, you are able to collect the remaining balance from an irate patient. The key factor within this circumstance is not to just acknowledge this fact, but to be ready to take appropriate action when it comes about.
Keep in mind that most insurance carriers have up to 30 days to either provide payment or the written denial of a claim. This delay means that, if you are going to achieve a more efficient process of AR management, you must have a proactive plan in place to substantially hasten the payment of claims once insurance claims have been denied.
What Can You Do?
The first step to take is to ascertain the validity of a denial. If a denial is due to a coding or billing error, you can most likely correct and complete the payment process with a simple phone call, form re-submittal, or brief appeal letter.
Given the volume of denials and frequent lack of staff resources, however, your best option for quickly completing the billing claims process is to prioritize those claims in a manner which will have the greatest effect on your AR management. This will include claims for large dollar amounts or an account that has numerous outstanding balances.
You’ve probably heard the saying, “There are bigger fish to fry,” and, when it comes to assigning your billing and coding resources, this adage definitely holds true. Prioritizing your larger claims only makes good business sense, but the appeals process for smaller claims can often be managed more cost-effectively by a third party, such as eReceivables. eReceivables has patented three automated collection procedures which have been specifically designed to accommodate small balance claims. Partnering with a third party such as eReceivables will speed claims collection and eliminate the need to hire and train additional office staff.
Chase the Big Claims
No doubt you already have your most experienced staff members managing the appeals process for large balance denials that will have the most impact on AR management. Still, there are some useful strategies that can help your staff become more assertive in denial management. Consider the following best practices:
Challenge the Insurance Reps
It is a well-known fact that insurance companies sometimes use delay tactics to stall the claims process. After all, they have their eyes on the bottom line as well. That’s all well and good, but this doesn’t mean that they should be allowed to provide inaccurate information. It is important to question them again when an initial response to a claim doesn’t make sense.
Know Your Stuff
Adequately training staff members and equipping them with adequate and current knowledge can be a challenge, but it must also be a priority. If you are going to establish efficient AR management, your AR team must be thoroughly knowledgeable about collections. In order to achieve the desired outcome of collecting payment, staff members must also be prepared to follow up with insurance companies in an efficient manner. To effectively supplement the knowledge base and availability of your staff, it is wise to have on contract a team of experts who have sufficient knowledge to help with the complexities of covered services, compensation, and other insurance-specific protocols.
Analyze the Account
Make sure you have reviewed and analyzed the account before you reach out to an insurance representative. Otherwise, you will only be wasting your time, as well as the time of the insurance provider’s staff. Write down the questions you have and, as much as possible, be ready to resolve them during the conversation or immediately after that. Taking these steps will help you efficiently wrap up the appeals process, instead of having to return to it again and again.
Ask Probing Questions
When you do make contact with an insurance representative, go into the process expecting to receive payment. Once you have taken every necessary step, put the ball back in the insurance company’s court, and begin to probe for satisfactory answers. Ask, as often as you need to, about the status of the claim and why claim processing has been delayed. Push one step further by finding out who you can speak with in order to help ensure faster payment.
You have a business to run, and so do the insurers who are denying payment. To achieve a healthy revenue cycle, you must approach the denial and appeals process with the mindset of this process merely being “business as usual.” Identify the largest claims, prioritize them, and direct your best resources toward successfully resolving them. This proactive strategy will help you collect payment as quickly as possible, and the result will have a positive impact on your AR management and your organization as a whole.
Consider going even one step further to make the best use of your resources. Farm out your small claims to a company like eReceivables to ensure timely payment. It is definitely an investment worth making.