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.
2. Denial and Rejection Rates are Above 4%
According to the Medical Group Management Association (MGMA), it can be detrimental to your business if your denial rates are above 4 percent. If your organization lacks effective revenue cycle management tools that provide business intelligence to help you manage denials, the effort to reduce denials may seem nearly impossible.
3. Regulatory and Compliance Creates Difficulties
With thousands of new ICD-10 codes being mandated, coding inaccuracies are still a real challenge many providers face. Coding inaccuracies usually lead to increased denials, so ongoing training is important. But the consistent training needed for your team to keep up with newly enforced requirements can take time away from more important tasks. Hiring an expert in regulatory and compliance who can oversee ongoing training will improve both the quality and speed of your daily workflow, putting the focus on effective denials management and increasing cash flow.
4. Unnecessary Denial Management Expenses
According to MGMA, the labor cost of reworking a denied claim is about $25 per claim. If you’re still submitting paper claims, the cost may be even higher. A 2016 Healthcare Information Management Systems Society (HIMSS) Analytics survey found that 31 percent of providers still use a manual process for managing denials. No matter how many claims your organization regularly submits, manual filing increases the chances of human errors, leaving you with the additional expense of refiling a claim.
Eliminate the roadblocks to a better revenue cycle
By using the right tools, your revenue cycle doesn’t have to be a series of “what ifs.” Addressing these four problems in your billing department is as easy as choosing an automated solution, such as the Medicare Enterprise package, that eliminates complexities, simplifies claims submission and gives you insight into your data so you can make informed decisions. This leaves you with less on your plate to worry about and more cash back in your pocket.