They are the scrutinizers. The claim sniffers. They are the auditors. Have you ever thought of why your claims are denied or paid? Is there a really smart computer or a human face behind that hits to go or the no-go button? It’s both. When you submit claims, they go through some really intelligent computer programs. These programs process each claim and flag irregularities. These red flags are then extensively analyzed by claim auditors.
Statistics show that over 50 percent of all medical facilities have successfully transitioned towards implementing an electronic health record system. While implementing EHR may mean streamlining operations and going paperless, the process tends to become mechanical and many look at it as mere data entry over time.
Want to fast track your reimbursement cycle? Different insurances differ in the time they take to process claims. Target easier insurance carriers with specific focus and see the change. One carrier which centers should look at is Medicare. It has a straightforward submission process coupled with fewer hassles for reconciling denials.
A claim can be denied even before a patient is seen by the physician. Essentially, the revenue cycle begins when a patient calls in to schedule an appointment. As simple as it may sound, the primary cause of most pre-visit denials is the lack of a checklist. What we don’t find in centers after centers, is the execution of the following list before every patient visit:
Tracking and reconciling denials are extremely crucial for every medical practice. They form a metric for practice performance and are a direct reflection of reimbursements. They also reveal loopholes in practice operations.
Presenting a collection of reports that form benchmarks for practice performance. These are a standard set of outlines that you can ask from your biller and are crucial for measuring and tracking practice growth.
Patient-centric healthcare delivery is the most important aspect of delivering quality healthcare. Thanks to advanced technology, patients are more informed and want to be more involved in their health planning and decision-making. The new legislation and regulations (e.g. Meaningful Use of EHRs, Patient Protection and Affordable Care Act (PPACA or Obamacare) point towards quality of service and patient satisfaction. Unfortunately, patient-provider encounters have become very mechanical. Exceptional providers genuinely care about the well-being of patients. Patient experience is just as vital as the billing process itself.
More than 50% of the medical fraternity has transitioned towards adopting electronic health records. As the second stage of Meaningful Use certification is upon us, let’s take an overview of what’s happening in the Meaningful Use EHR program.
How many times have your claims been denied for having a pre-existing condition? How many times have you re-submitted / appealed those claims? Have they ever been paid? How do you proceed?
There are claims that get paid and then there are those that are denied. What signals a claim to be passed over? Patient eligibility, correct coding, timely submission, etc. – all can determine if the claim will be paid. Practices often don’t realize the importance of referrals in getting the claim paid. If you miss a referral, the claim is most certain to be denied. Also, the more patients referred to you, the better your reimbursements.