6 Denial Prevention Strategies to Improve Your Medical Billing and A/R
Quick,efficientcollectionofaccountsreceivablesisessentialtothe sustainabilityandgrowthofanyhealthcareorganization–regardlessofsize. Withmedicalservicesoftenprovidedbeforepaymentiscollected,proper protocolsneedtobeinplacetoensurestrongcashflow.Incorrectpatient information,inefficientclinicaldocumentation,improperclaimfollow-up procedures,andpoorlytrainedA/Rstaffresultinslowclaimprocessing.
Here are six practices you can implement right now to help improve your cash flow:
Patient Registration and Information
Obtainandmaintaincorrectpatientdata.Incorrectpatient/guarantor demographicsorinsurancedetailsresultindelayedpaymentsandlost revenue.Responsiblepartiesmaynotreceiveinvoicesandpayorsmaydeny claimsfor‘Subscriber/membernotfound’or‘Informationsubmitteddoesnot matchrecords,’whichaddsunnecessaryvolumetoagingclaimrecords.Left unaddressed,claimsaredeniedandthesedatagapsrequiremorestafftimeto correctandresubmit.
Best Practice 1: Ensurestaffareverifyingandupdatingpatientinformation everytimepatientscomein.
Whenappropriateandaccuratepatientdataiscollected,thebenefit verificationprocessissmoother.
Best Practice 2: Educateyourteamaboutquestionstheyshouldask,show themhowtoidentifycommonpatientemploymentstatusandageerrors,and letstaffknowifuniquecircumstancesshouldbehandleddifferently.
Itisveryimportanttocapturethoroughpatientdataonthefrontend.
Clinical Documentation and Coding
Sinceclaimchargesaredeterminedbythepatient’smedicalrecord documentation,documentationintegrityandcodingcaptureprotocolsensure thatclaimsareprocessedandpaidontime.
Best Practice 3: Ensureyourprovidersunderstandtheimportanceand impactofpoordocumentation.
Improperdocumentationcanresultinmissedorincorrectcharges,which translatestodelayedorlostrevenue.Itcanalsotriggeraudits.
ClinicalDocumentationIntegrity(CDI)andComputer-AssistedCoding(CAC) softwarehelpidentifyandeliminateinadequateclinicaldocumentationand chargecaptureerrors.WhenusingaCDIand/orCACsoftware,notonlywill theclinicalrecordsbemoredetailedandaccurate,butcoderswillalsohaveall theinformationtheyneedtocodeaccounts.InadditiontoCDIandCAC, internalauditingsoftwarealsohelpsidentifymissedrevenueopportunitiesor redflagsthatcouldtriggeraudits.
Best Practice 4: Embracethetechnologyavailabletoidentifyandimprove documentationandcoding.
Thecosttoobtainsoftwareandtrainyourstaffissmallcomparedtothe revenueimprovementsyouwillsee.
A/R Follow-up
Follow-upiskeytosteadyrevenuecollections.Often,manyservicesare providedinadvanceofpaymentwiththeassumptionthattheinsuranceor financiallyresponsiblepartywillpaythebalanceoncetheinsurancehas processedtheclaim.ItistheresponsibilityoftheA/Rteamtomanageall openandoutstandingunpaidclaimsthatarependingpayment.
Best Practice 5: Timelyfollow-upofagingclaimshelpstoidentifyand preventerrortrendsinotherrevenuecycleareas-preventingrevenueloss duetolatefiling.
HavingateamofA/Rspecialistswithadeepunderstandingofpayor guidelinesandknowinghowtocommunicateeffectivelywiththeinsurance claimrepresentativesisimportant.Often,insuranceclaimcentersprocess claimsincorrectlyforvariousreasons.Manytimes,theyhaveincorrect informationonproviderparticipationandprogrammingeditsthat erroneouslydenyorunderpayclaims.
Morecommonly,whencontactingaclaimsdepartmentregardingan underpaidordeniedclaim,A/Rspecialistsareinstructedtosubmitanappeal and,insomecases,anappealisnecessary.However,appealingclaimscan delaypaymentlongerastheaverageappealtakesapproximately60days.
YourA/Rspecialistshouldclearlyidentifywhytheclaimwas denied/underpaidandwhatstepstotaketoreprocessit.
Best Practice 6: YourA/Rspecialistsshouldknowhowtoreadand understandremitanddenialcodesastheyarelistedonEOBs/EOPs,andthey shouldknowhowtoreviewclinicaldocumentationforappropriateclaim correctionsandresubmissions.
Moving Forward
WhilethereisnoonesizefitsallapproachtocollectingmoreA/R,itis importanttoknowwhatoptionsareavailableandtohavetherightpeopleor technologyinplace.Adequatestafftraining,clearandconsistent communication,andtechnologyaregreatwaystocollectA/R.
Source of content:
https://www.agshealth.com/blog/6-denial-prevention-strategies-to-improve-your-medical-billing-and-ar/