Are you overwhelmed hearing about the medical practice revenue cycle and all the pressures to recoup a provider’s revenue? Pressures from Insurance Companies, vendors, clients who owe for services?
Are you tired of hearing statements like:
- The patient is now the third largest payer;
- It costs at least $25.00 to work a denied claim;
- Upwards of 67% of denied claims don’t even get worked;
- CMS rejects nearly 26% of all claims and up to 40% of those claims are never resubmitted?
How about getting control of your A/R with tools and features you may already have at your disposal?
This article will look at A/R from the EDI Clearinghouse perspective. The following offers a sampling of the many features and functions you may already have at your fingertips within MicroMD and/or an integrated EDI Clearinghouse partner. The importance of integration between the two systems cannot be overstated. The flow of data and having one “source of truth” will aid your staff’s efficiencies and workflows immensely.
We start with an average medical practice’s revenue cycle:
Understanding a Patients Benefits:
An integrated eligibility solution will allow the practice to know what benefits, deductibles, and copays a patient has available as they receive services. Being able to collect what’s owed to the provider saves time and money. Collecting patient responsibility payments will save your practice time and money because less statements will be sent. This will tighten your revenue cycle due to receiving your money upfront.
Provide a Patient Cost Estimation:
Providing an accurate estimation of the services rendered allows for transparency and enables a discussion on payment opportunities. Being able to provide in a seamless, efficient manner aids in a positive experience for the patient while cutting down A/R.
Getting Clean Claims out the door faster:
Clinically scrubbing claims allows a practice the opportunity to maximize the reimbursement as well as cut down on rework – appeals and resubmissions. The best way to minimize lost revenue as a result of denials & rejections is by avoiding the issue altogether via clean claim submission. This service offers an in-depth “cleaning” of patient demographics, coding, medical necessity, and compliance checking on claims.
Working Denials Efficiently:
Utilizing a good ERA Denial Manager, providers are able to view transactions denied for a specific group or reason code, print an EOB for a specific claim, assign denials to staff for follow-up, and view the detail payment and allowed amounts for a billed charge.
Reporting and analytics should give providers a detailed view of trends in denials by reason code, top 10 denials and expected payment amounts. Using our Manage Expected Amounts feature, providers can determine if the maximum allowed amount is being received from the payer. Knowing what happened on the backend will allow for strategies to employ on the front end – so these denials don’t happen in the future.
To learn more, attend the upcoming Webinar on April 8, 2020 at noon EDT.Register Here