Healthcare providers are facing a number of stiff challenges today. In addition to stiff business environment, they are constantly challenged by changing rules and regulations, rising customer expectations and spiraling costs. Internally, the challenge lies in streamlining processes and keeping it efficient at all times. One such process that demands a high level of consistency is medical claims processing. Risk managers are struggling to keep the process simple, straight and error proof.
One significant challenge faced by risk managers today is to manage risk and losses with greater degree of precision. This is always an arduous task because claims data cannot be found in one place. It is spread across diverse systems. Fetching them safely and seamlessly is easier said than done.https://outsourcercm.com/blog/top-3-claims-management-tips-health-payers/
Though automation can help make this process seamless, most providers are still undecided about adopting it. Most of them prefer to bank on Risk Management Information System (RMIS) to manage claims. As a tool, RMIS can be effectively used to manage risks. It comes equipped with features that help providers with a range of claims management benefits such as streamlining workflow processes, organizing data in a single system and carry out data analysis to enable informed decision making. All these play a big role in improving claim outcomes.
| Did You Know
The total amount denied in medical claims adds up to $262 billion. Out of this, nearly 30% of claims are ignored, denied or lost. Out of all the denied claims, 65% of them are never reworked. About 90% of denied claims are written off by hospitals. This amounts to $3.5 million. About 86% of errors committed by healthcare providers are administrative. |
Ways to Improve the Claims Process
Data Update Tools and Services
RMIS systems is the most commonly used system to collect and consolidate data. It gives providers -the tools needed to import necessary data from third-party and carriers. Providers can collect all information pertaining to claims and claims-related issues. Most importantly, this information can be fetched as per your needs – daily, quarterly or monthly basis. In fact, a cloud-based RMIS comes with several on-screen tools to make the process of importing data fast and safe with proper encryption.
Third-Party System Integrations
Integrating third-party systems with RMIS comes with its own set of benefits. It streamlines medical claims processing by eliminating data silos, reducing burden on resources like entering data into different systems and weeding out chances of mistakes from processes. The integration needs to be seamless so that the data exchange between accounting, HR, and other departments is seamless. A smooth integration also ensures that the application can be used completely to one’s advantage.
| Did You Know
The total healthcare transactions every year stands at 30 billion (15 billion faxes). It costs nearly $250 billion to process this. |
Document Management
Integrating a document management system can put an end to wayward document maintenance. This can be a big step towards streamlining claims processing. For instance, it puts an end to spotting critical documents on time. A DMS helps a provider to move to a paperless environment. This way it helps to store and locate critical files in a jiffy. Several advanced DMS come equipped with features that make doc management simpler. For instance, one can attach scanned versions of paper documents to a record existing in the system. This eliminates chances of delay due to missed files. Likewise, it helps you send email file attachments directly to claim records, look for particular files with specific words or phrases, view recent documents by clicking recently opened files.
Automated Workflows
Medical claims processing staff are perpetually running short of time. They have to perform slow and repetitive tasks that not only slow down the process but also make it prone to errors. Therefore, automating workflow can be hugely beneficial to them. For instance, triggering alerts for issues like change made to claims details, or exceeding accepted threshold can be extremely helpful. Professionals can have a closer look and take corrective measures. Automation thus makes it possible to standardize procedures. This leads to greater efficiency and reduced claims delays and denials.
Analytics and Benchmarking
The ability to analyze claims made and received over a period of time is critical for smooth operations. It helps to analyze a range of anomalies that need to be corrected for ease of operations. There is several software that addresses these issues. It pulls out similar claims from a system over a certain period, compares it and displays the results on a chart, to help you understand deviation in the process or trends. An automated retrieval of figures along with an apple-to-apple comparison makes it easier to comprehend issues because they flare up and become unmanageable. Besides, advanced claims processing software can also help to benchmark claims against a set of parameters derived from lessons learnt from other lost-time cases. Such tools can even assign a score to the claims high risk cases can be spotted early and dealt with seriousness.
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EHR Statistics About 67% of healthcare providers are using an EHR. Healthcare providers can save $177 million annually by using electronic claim submissions. Electronic claim submission can help providers save 1 minute per transaction. |
Dashboards and Reports
Medical claims processing becomes a lot easier when you have a clear picture before you. Such pictures can be created with the help of dashboard reports. There are several claims processing software that can be used to create customized dashboard reports. Most of them come equipped with hundreds of standard dashboard templates that can be tweaked to meet particular needs. Many of them even have an auto schedule feature to distribute reports to stakeholders. Stakeholders can view the reports time to time to get strategic insights to make informed decisions.
Conclusion
A proven way to streamline healthcare claims management is by embracing an integrated claims management solution. Such a tool must come equipped with features like workflow automation, data analysis and intuitive reporting to help you accomplish all critical things with the click of a mouse. You also need to ensure that the solution is cloud-based, scalable, and comes with a wide range of integration options. Third-party partners have vast industry experience and the right technology mix, to manage claims with greater diligence. They have, over the years, set such high standards in handling claims management that outsourcing claims management has emerged as the best option to manage claims.
Who We Are and What Makes Us an Expert?
This blog is brought to you by Medbilling Experts. We are an expert provider of medical back-office support services. We believe effective healthcare claims management is not just about settling claims properly and without any delay. It involves doing things right, right from the word go so that the right standards are set and maintained. This includes being on top of healthcare technology trends, having fingers on the regulatory pulse and keeping a B plan ready to fire fight uncertainties like the pandemic.
If you are looking for a robust back-office claims processing services for guaranteed outcomes, get in touch with our us now.
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