Using Healthcare Workflow Efficiency Tools to Improve RCM
There are, undoubtedly, countless challenges to running a successful healthcare practice. Unfortunately, some of those challenges may be...
7 min read
Robert McDermott Jul 18, 2024 1:32:00 PM
Healthcare is a necessity for the “customers'' and though it functions as a business, many of the practitioners never entered the field with an eye on business first. For the new practice owner, the established owner and the office manager, patient care takes precedence. However, a successful healthcare practice requires resources dedicated to administrative and business tasks or both the practice and patient care suffers. Despite this need, many practices still struggle with healthcare billing and claim denials.
Unfortunately, the administrative and business side of a healthcare practice dictates its success as much as patient care and experience. Thankfully, the two aren’t mutually exclusive and attention to billing issues can boost patient satisfaction and practice success.
Quick Links:
Healthcare billing issues and claim denials impact both providers and patients and are, therefore, a significant concern.
To start, for healthcare practices, both billing challenges, such as accounts sitting in AR, and claim denials translate to revenue loss. Ideally, keeping items in AR at 35 days or less should be a goal, with anything over 90 days a rarity. Days in AR is an invaluable metric when it comes to evaluating RCM.
Similarly, claim denials mean delayed payment as well and can significantly impact your bottom line. Further, they also increase administrative costs. Managing and rectifying denied claims is a time-consuming process requiring additional resources to investigate and correct errors, appeal denials, and resubmit claims.
Not only do these tasks divert staff from other important duties, but it comes with a significant operational cost as well. In fact, it’s estimated that healthcare providers spend nearly 20 million dollars a year on addressing claim denials.
As one might suspect, this resource diversion impacts on operational efficiency. Frequent billing issues and claim denials can disrupt the healthcare workflow within organizations and practices. Staff must spend considerable time addressing these problems, often with a lot of phone calls, which not only reduce overall efficiency and productivity, but also impacts patient care and relationships. This diversion of resources can also affect the quality of patient care and the smooth operation of the practice.
And, when it comes to patient care, billing issues can lead to delays in needed procedures or treatment. In some cases, patients may forego care altogether if they cannot afford to pay out-of-pocket costs while waiting for claim resolutions. And, for providers, that can mean an over 8 point reduction in patient satisfaction, which comes with additional consequences.
Beyond the impact on your practice and patient experience, delays can also add to financial stress on patients. Claim denials may result in unexpected bills or out-of-pocket expenses for patients.
Finally, incorrect billing practices and high rates of claim denials can attract scrutiny from regulatory bodies. Providers must adhere to strict healthcare billing regulations and guidelines. Failure to do so can result in audits, fines, and legal action, further exacerbating financial and operational challenges.
We hinted at some of the bigger concerns with healthcare billing issues and claim denials and noted the very real truth: they come with substantial financial costs, impacting both providers and patients. The burden extends beyond immediate financial losses, influencing operational efficiency and patient care quality and the numbers reveal just how big that impact is.
In short, we’re able to calculate the costs, to providers and patients, when it comes to healthcare billing concerns and claim denials. Of course, we need to be able to identify where the problems are so we can reduce or eliminate them.
Claim denials in healthcare billing can be traced to various issues, ranging from administrative errors to more complex billing compliance problems. Understanding these common issues can help providers take proactive steps to minimize denials and streamline their billing processes.
The list may seem daunting and a bit overwhelming, but, as we’ve established, the cost of not addressing these issues can be even more significant. And, thankful, a few of the right tools can help you mitigate these risks to successful and efficient healthcare billing and claims.
Resolving healthcare billing issues is crucial for enhancing practice revenue and maintaining financial stability. Thankfully, your tech stack quite literally holds the keys to alleviating many of these concerns.
One effective approach is implementing automated insurance verification software. Not only does this reduce claim denials due to coverage issues but it also enhances the patient experience by streamlining the check-in process.
Real-Time Eligibility Checks: Implementing automated insurance verification tools allows practices to verify patient coverage in real-time. This ensures that services provided are covered under the patient’s insurance plan, reducing the risk of claim denials due to coverage issues.
Improved Patient Experience: Automated insurance verification streamlines the check-in process, minimizing delays and enhancing patient satisfaction. Patients are more likely to return to practices where administrative tasks are handled efficiently.
Reduced Administrative Burden: Implementing this solution allows administrative staff to focus on patient experience and care as well as other critical tasks. As a result, practices see increased overall productivity and reduced human error in eligibility checks.
Coding assistance tools help provide rapid coding assistance using predictive text and allowing you to easily and quickly select the code you’re looking for based on coding standards and guidelines.
Enhanced Accuracy: Medical and dental coding support helps leverage both AI and machine learning to accurately code procedures and diagnoses, significantly reducing the risk of errors that lead to claim denials.
Compliance Assurance: These tools are regularly updated with the latest coding standards, ensuring compliance with payer requirements and reducing the likelihood of denials due to outdated or incorrect codes.
Increased Efficiency: Not only does coding assistance reduce errors, but it also frees up staff time, allowing them to focus on patient care and other essential administrative tasks. This efficiency translates to faster claim submissions and improved revenue cycles.
Outsourcing billing and claims to specialized third-party providers can also be highly beneficial. These providers bring expertise and experience in managing the complexities of healthcare billing and coding, leading to higher success rates in claim submissions and appeals. This translates to quicker reimbursements and improved cash flow.
Access to Expertise: Outsourcing healthcare billing and claims to specialized third-party providers gives practices access to experienced professionals who are well-versed in the complexities of medical billing and coding.
Improved Cash Flow: Professional billing companies often have higher success rates in claim submissions and appeals, leading to quicker reimbursements and improved cash flow for practices.
Reduced Overhead Costs: Outsourcing enables practices to reduce the costs associated with in-house billing departments. This cost-effectiveness can positively impact the practice’s bottom line.
Healthcare billing challenges and claim denials shouldn’t impede your practice’s ability to grow, especially when the tools to overcome them are available. If you’re ready to see how these workflow solutions can revolutionize both the administrative and patient care sides of your healthcare practice, book a demo with the iCoreConnect team today.
There are, undoubtedly, countless challenges to running a successful healthcare practice. Unfortunately, some of those challenges may be...
Wondering how to make a home repair? Car repair? Get a good workout? Learn a language? There’s a video for that. Increasingly, in classrooms across...
There is no role in healthcare responsible for only a single task. From front office and administrative staff to healthcare providers themselves,...
In 2003, more bills were paid via check than any other payment method. By 2012, that number plummeted, eclipsed by payment cards and ACH. This was...
When we ask dental and healthcare providers about the hardest part of running a practice, many tell us it’s what happens outside the exam...
When you set out to become a healthcare provider, you probably didn’t anticipate that every practice owner could benefit from a business degree. But...