1. How to maximize Claims submission and edit resolution?

Submit claims every day.
Timely submission of claims is key to reducing the A/R days and gives sufficient time to identify any possible errors before claim submission.

Quick Edits.
It is best if you can work edits within a day. One of the top reasons for claim rejections is the failure to identify charge entry errors. It is crucial to create a systematic process for edit resolution and claim corrections to reduce claim denials and accelerate cash flow.

Maintain dedicated staff.
Edit resolution is a recurring process and needs dedicated staff with adequate skills and experience. An experienced staff is more acquainted with edits and can find faster solutions and give better insights on more complex issues

2. What are the best practices for payment posting

Automation.
Automating critical processes is the simplest solution to reducing inaccuracies in healthcare revenue cycle management. It is critical to post payments with accuracy to accelerate revenue cycle performance.

Denials and adjustments.
Denials and adjustments in healthcare revenue cycle management is a significant part of the payment posting process. You need to document the essential details for future reference—as payers may deny the entire claim or a specific line item in the claim.

Secondary and Tertiary payers.
Most often, secondary claims are submitted electronically. However, the secondary claims may be submitted with mistakes if the primary claim has any errors

3. How to handle Credit balances and refund processing?

Establish a clear strategy.
Streamline your refund processes for effective healthcare revenue cycle management and present accurate data.

Quick Refunds.
Quicker refunds within a span of 60 days are recommended for higher patient satisfaction and better patient experience. Delayed credit checks could be a leading cause of patient frustration and could create a negative patient experience and unsatisfied consumers.

Automate the process.
Automation in critical medical billing processes like refunds helps reduce staff time and costs while improving efficiencies. Automation also helps effectively manage credit balances.

4. How to optimize insurance accounts receivable follow up?

It is critical that you build a team of well-trained and experienced professionals who can efficiently follow up with insurers on claims—from claim denials to payment. Research indicates that a whopping 20% of claims are processed incorrectly. This averages out to 1 in every 5 claims, which significantly impacts the cash flow. A skilled healthcare revenue cycle management expert can efficiently follow up with denied claims and maximize reimbursements.

5. What are the best practices for denial resolution and appeals?

Effective management of claim denials is a key factor in healthcare revenue cycle management. Organize claim denials into categories and identify the missing pieces of information in denied claims. This way of root cause analysis helps evaluate claim reports and reduce denial rates in the future. Get into the specifics of the information collected. For instance, superficial information would indicate a missing preauthorization, but when you delve deeper, you will figure out where exactly in the process, it went wrong.

6. How to improve customer service and patient pay

Establish detailed and automated reports with analytical insights on patient needs. Insight-driven healthcare models help you save staff time and resources, for instance, by identifying patients who don’t need multiple touchpoints and follow-ups to make payments.

Set clear goals on the expectations and define responsibilities. Use analytics, trackers and automation tools to generate performance reports and insights on improvement areas. Track the progress of processes and reward employees who have met and exceeded the defined goals.

Also, include patient experience professionals in your healthcare revenue cycle management team—to continuously follow-up with your patients on payments and address any other billing and payment related concerns. This is a crucial role that involves insurance adjudication and patient experience management. Hence, consider recruiting well-trained and experienced staff for the role.

7. How to identify under payments and resolve them?

Advanced digital healthcare solutions and automated tools help identify variances quickly. Studies show a staggering 7-11% of underpayments in the U.S on an average, which negatively impacts cash flow in practices. This is a huge amount, which cannot be overlooked by care providers.