For healthcare providers, claim denials are just a routine part of business. It seems you can’t completely escape them no matter how hard you try. You’ve heard the statistics: The average claim denial rate across the healthcare industry falls between five and 10 percent, according to an American Academy of Family Physicians (AAFP) report.
Denials can hit your healthcare organization where it hurts. According to MGMA, the average denial rate of a physician practice ranges from five to 10 percent. The median 350-bed hospital saw average write-offs from denials rise to $7 million in 2017.
How do you know if your healthcare organization’s business performance is clicking on all cylinders? Many organizations have invested in business intelligence tools to help measure internal performance, evaluate areas of improvement, and identify best practices to improve cash flow. Yet, what exactly are “best practices”? How can organizations know if their practices really are best? How do you get a true apples to apples comparison?
Processing times, denial rates, cash flow and alternative payment models – all just a few of the many business challenges healthcare organizations face. As providers identify areas in which to focus their efforts and maximize performance, a growing number are investing in business intelligence (BI) solutions featuring comparative analytics. These solutions help organizations identify areas of the business in which improvements will offer the greatest ROI.
Hospitals are writing off more claim denials as uncollectable than ever before, posing a concern within the industry. For an average 350 bed hospital, the potential cost could be as much as $3.5 million in lost revenue. As the industry moves toward value-based payments, proving medical necessity may further increase denial rates. We’re left wondering how losses from denials have spiked and what hospitals can do to prevent them.
Accuracy and oversight matter in home health billing. Agencies must be on top of their business practices to avoid denials. This includes managing detailed documentation procedures and the most accurate billing processes possible. Knowing the top reasons home health agencies receive denials based on medical review and how to avoid them will keep your agency on top of its reimbursement game. Check out our infographic to learn more.
Billing departments have a tough job processing insurance claims, and most are under immense pressure to make sure they are accurately billing patients and payers. Under daily stress, it's easy to lose sight of the obvious problems that might be holding back your billing department. Here are four common problems that once identified, you can easily address.
1. Limited Business Insight
How often does your organization access and evaluate internal billing reports? Is your billing department tracking denials or Days in A/R on a regular basis? Or do these items get attention only when there's "extra" time? If your in-house billing department seems to be drowning in work, they may be too busy to regularly check and properly analyze valuable data. Without an organized system that enables your team to regularly assess your organization's billing trends, your chances of easing pressures and improving workflow are slim.
Step 3: Claims Management and Business Intelligence
So far in our Bill Well and Prosper blog series, we’ve outlined ways to improve your eligibility and claims submission process for a thriving business. You’ve done everything to secure reimbursement by confirming eligibility and maximizing clean, timely claims submission. Now what? It’s time to manage your claims and embrace robust business intelligence to take your organization and cash flow up a notch.
In the medical billing industry, a clearinghouse is a valuable resource. Take a look at these items to quickly learn how you can transform your claims processing by using a clearinghouse.
Reduce Rejected and Denied Claims
If you’re filing claims the old fashioned way or maybe your clearinghouse isn’t up-to-date on the latest payer edits, be aware that human error is the number one cause of rejected claims. In fact, the average error rate can be as high as 30 percent, causing your rejected and denied claims to jump drastically.