Medical claims processing is the bread and butter of a healthcare provider. It is the process when the overall amount due with a treatment or procedure is submitted to the insurance business to deliver on its agreement with the customer. On the healthcare providers front it involves reviewing the billed amount for coding and coverage and submitting it with the insurance carrier.
Claims processing is challenging because it involves addressing at least a dozen steps before submitting the bill to the payer. Some processes in vogue today are outdated because a lot many practices still depend on paper medical records. Those who do not depend on paper-based transactions are hit by other factors like shortage of skilled resources and high attrition rate. There are ways to improve claims processing efficiency to ensure accuracy during this complex workflow.
Given that an average American spends $8,000 annually on healthcare, and the bulk of this expense goes into health insurance, it is important for healthcare providers to find solutions to recover the treatment expenses from insurance carriers. A good healthcare claims management process can not only guarantee complete reimbursement but also lead to greater patient satisfaction.
Best Practices to Streamline Medical Claims Processing
Medical claims processing can be streamlined in a number of ways. Some of these ways include consolidating processes, embracing right technologies, outsourcing healthcare claims processing and so on. Each of these ways are proven. Sometimes embracing one particular way, like outsourcing medical claims processing can change the way you do things. Sometimes a mix can help you get more efficient. Given below are few established ways for streamlining healthcare claims management.
Consolidating Workflows or Departments
Nowadays, all claims are processed electronically. This is a HIPAA requirement. Yet there are key aspects that need to be handled manually. These manual aspects of claims handling have to go through multiple departments before it goes for submission. This makes it a time-consuming process. Sometimes, the workflow in different departments may not be the same because of reasons specific to the department.
Consolidated workflow for medical claims processing can help overcome this problem. Such a workflow reduces the number of touch points thereby reducing the risk for delays and errors. The biggest benefit of having a unified workflow across departments is that it streamlines workflow processes, consolidates claims data in a single system, and helps in carrying out accurate analysis for informed decision making.
Improving Information Technology Systems
Though technology plays a big role in the healthcare industry, claims processing remains one area where processes are dismally behind. The key to improving accuracy in claims management is banking on advanced tools and technology. For instance, using different templates for claims submission has always been a struggle for clinics and hospitals. Automation solves this problem to a large extent. It automatically matches all necessary data points to streamline claims submission. It ensures no data gets missed and errors are spotted before they become an issue.
There are host of other tools to improve claims management. For example, the document management tool can be very handy. It makes your environment paperless. Besides, it helps you to find critical files effortlessly, centralize storage of claims related document, attach scanned versions of documents, email attachments to claims record. Likewise, analytics tools help you analyze the fast-generating data in a matter of seconds and report generating tools help you see financial status at any point of time.
Auto-Adjudication to Improve Claims Efficiency
Claims adjudication is the process by which an insurance agency reviews a claim to determine if it has to be paid in full or part or denied altogether. Though, the process lies in the ambit of the carrier, a beforehand know how helps you know how much to expect and how to keep customers prepared for out-of-pocket expenses. It also helps in processing claims faster and more accurately, thus helping in improving patient experience.
An auto-adjudication tool can help make medical claims processing a lot easier. Integrating an auto adjudication tool in the claims processing workflow, will enable providers have a more transparent view of the reimbursement process. Besides, the claims will be processed faster, the healthcare provider will get reimbursed faster, and there will be no pile up of claims on both the provider and carrier’s end.
Be Informed
A lot of things in the medical industry keep changing on a regular basis. This is mostly necessitated by changes introduced by regulatory bodies. The best way to stay on top of these changes is to stay informed about them. More often than not the changes are too sudden. If billers aren’t aware of this, they may process bills the wrong way. Therefore, staying informed about changes is of paramount importance to smooth claims processing.
In healthcare claims management it is important to stay updated about coverage policies, coding changes, filing limits, global policies, etc. Besides, claims processing, the changes can have an impact on internal processes as well. Therefore, keeping track of them can also be very helpful. For instance, keeping a record of denial stats can help you cut down on the denial rates. This includes denial reasons and rates and recurring denials. Likewise, being informed, can ensure there are no more claims resubmission.
Outsourcing Claims Management Services
Medical claims management is a specialized job and is best handled by someone who specializes in it. A back-office support provider can help you tackle all challenges associated with claims processing. Their end-to-end support process covers every aspect of claims processing from stem to stern i.e., from handling health insurance correspondence to quality control.
The biggest benefit of outsourcing claims management to healthcare claims processing companies is that it frees up time for you to focus on other tasks. Besides, it also helps you save money and fire fight issues like attrition, quality and training. Tasks like clarifying monetary questions to patients or seeking prior authorizations from insurers can be too mundane tasks to be handled internally. Letting someone take care of it on your behalf and with consistent and assured quality levels can bring a huge difference to managing claims.
Conclusion
The easiest way to handle claims processing is to outsource it to third-party healthcare claims processing companies. Healthcare providers who find claims processing to be very overwhelming or are struggling to straighten the process can bank on third-party service providers to get over all associated challenges. The benefits of outsourcing claims processing are far too many, most of which are hard to attain with an in-house set up.
Who We Are and What Makes Us an Expert?
This article is brought to you by MedBilling Experts, a specialized third-party service provider for medical claims processing services. We have over 10 years of experience in assisting US-based clinincs and hospitals streamline their healthcare claims management process. Driven by a team of industry experts and the best of technology and processes, we make sure your claims processing needs are met smoothly. If you are looking for a result yielding claims processing solutions, get in touch with us now.
