Tag: Revenue Cycle Management

Imagine being able to offer your patients a financial experience that doesn’t stress them out. That makes patient billing quick and simple. That knocks off a few minutes from each patient registration. And that even boosts your revenue. These are just some of the benefits attendees at last week’s Cerner Health Conference were considering as they discussed opportunities for faster innovation, smarter working and transformation in the future of healthcare technology. When it comes to working smarter, attendees seemed to agree that one aspect of the healthcare experience comes out top for providers and patients alike: the cost of care. This is especially true because patients are increasingly responsible for paying their healthcare costs. And since the way services are reimbursed is constantly changing, patients are often left in the dark about how much they’ll have to pay, or how they’ll be able to afford it. Patients are struggling under the weight of financial burden We know this can have serious implications for their physical, emotional and financial health. A recent survey by the Nationwide Retirement Institute showed that as many as one in three patients aged 25-45 are delaying medical care because they’re worried about the cost, instead keeping their fingers crossed and hoping that the issue will disappear by itself. A third shop around for better prescription prices, with many not taking their meds as often as instructed in order to save money. More than half of patients wouldn’t be able to afford an unexpected bill over $1000, while a staggering 530,000 families are bankrupted by medical costs every year. Healthcare providers often end up bearing the burden of uncompensated care, or waste valuable time and resources working to uncover missing or undisclosed coverage. Either way, all this wrangling for payment has a major impact on the organization’s bottom line as well as the patient financial experience. To tackle some of these challenges, we’ve teamed up with Cerner® to support healthcare organizations to provide more compassionate and convenient billing practices. At last week’s conference, we launched the Cerner Consumer Financial Engagement suite, a newly embedded experience within Cerner’s Consumer Framework that will optimize the billing process for both patients and providers, powered by Experian® data. 3 ways the Cerner Consumer Financial Engagement suite can optimize your patient collections One of the biggest pain points for patients when it comes to managing their healthcare bills online is needing to switch between different systems for different administrative tasks. This new partnership will let patients who use the Cerner Consumer Framework access and manage all aspects of their online healthcare account in one place, creating a more convenient financial experience. The new tool will help providers improve patient collections in three ways: Smarter patient engagement When you have insights into your patients’ financial circumstances and propensity to pay, you can make more informed decisions about how to approach collections and get them on the right program from the start. Using Experian’s industry-leading datasets, providers will be able to use the Consumer Financial Engagement suite to spot patients who may benefit from alternative payment plans or financial assistance and make personalized offers that are compassionate and relevant. Giving patients a one-stop-shop for managing bills Patients are coming to expect a better experience – similar to what they might see in online retail and financial services. When it’s easy for them to settle their bills, they’re more likely to conclude their healthcare journey on a positive note and feel reassured about sticking with your organization the next time they need care. With an all-in-one patient dashboard showing current billing information, insurance deductible status, transparent cost estimates and tools to activate pay plans or financial assistance, the Cerner Consumer Framework creates a frictionless and transparent billing experience, leading to fewer late or unpaid bills and more satisfied patients. Simple and efficient collections When it comes to payments, proactive communication can help ward off some of the sticker shock that comes with unanticipated treatments and bills. The new financial engagement tool uses a simple interface that makes medical billing clear and quick for patients. When consumers aren’t put-off by the technology, they’ll be more likely to act promptly to get billing out of the way. In addition, providers will be able to add their own branding, so the patient experience is consistent from start to finish. Creating a positive patient financial experience powered by reliable data In today’s climate of increasing costs, big data and healthcare consumerism, data and analytics are now the driving force behind an efficient revenue cycle. Person-centered healthcare services that prioritize quality and patient outcomes should be a given, but the financial experience is an integral part of the total equation. This is especially true when we consider that the three biggest pain points for consumers during their healthcare journey are all related to payments! Learn more about how data-driven technology, such as the new Cerner Consumer Financial Engagement suite, can help you offer patients a better financial experience and optimize revenue at the same time.

Managing the revenue cycle draws in considerable resources for healthcare organizations, even when it’s working as planned. The American Medical Association puts direct transaction costs and inefficiencies associated with the “claims management revenue cycle” at around 25-30% of overall healthcare spending. But when errors are made and claims end up being denied, providers could end up missing out on as much as   The total revenue leakage is probably higher, when you consider the opportunity cost of staff time spent sorting out denials. Among the most common reasons for denials are missing or incorrect billing information, non-covered charges for care, and absent authorizations. Thankfully, these are all issues that can be minimized with the right strategies and tools. By optimizing your revenue cycle from the outset so that claims are right first time, you can save hassle and expense later on. Here are 7 ways to proactively reduce claim denials in your health system. Figure out why claims are denied First things first. You need to understand where denials are occurring in your revenue cycle and why. You can determine the root cause of denials by analyzing data that’s already available to you alongside information on industry trends. A business intelligence tool can help you use advanced data analytics to find opportunities for improvement, and generate actionable insights that are focused on your specific KPIs. Once you know where the weak points are, you can get the ball rolling with solutions. Prioritize the big-impact fixes In all likelihood, most providers will have the opportunity to improve the claims process at several points in the revenue cycle. You can’t do everything at once, so identify the areas with the greatest potential impact on your hospital’s bottom line. Can denials be traced to a particular department, service line or physician? Has a certain payer changed their approach? Compare the cost of implementing processes to tighten up the weak points in the cycle with the amount of revenue likely to be recovered to ensure you get the biggest ROI for your efforts. Automate patient access for more accurate claims Up to half of denied claims occur early in the revenue cycle, during patient access and registration. Automating the patient access workflow with real-time data can create a more efficient and accurate process, linking front and back office staff with shared systems that minimize errors and staff time. Martin Luther King Community Hospital experienced these efficiencies first-hand, when they integrated eCare NEXT® within their existing Cerner® system. As a result, their registration process became more streamlined, enabling them to cut two to three minutes from more than half of their registrations. Ensure patient matching is as accurate as possible Incorrect patient matching is a major source of revenue leakage for many providers, with around a third of claims denied on the basis of inaccurate patient identification. When it costs $25 to rework a claim and around $1000 for each mismatched pair of records, that’s a lot of lost revenue. Resolve your patient identities with the most robust data sources, and not only will you reduce claim denials, you’ll also have a more complete picture of each patient, which in turn will give them a better patient experience. Streamline prior authorization checks A survey by the American Medical Association found that prior authorization checks created a substantial burden for providers, with physicians spending an average of nearly 15 hours per week dealing with related tasks. For patients, this process can lead to delayed or even abandoned treatment. Using automated software, you can check claims against payer rules for medical necessity, frequency, duplication and modifiers, so you can quickly spot any claims that may be denied and correct them before submission. Process claims effectively Once you’ve streamlined the front-end of the claims process, you should of course look for ways to improve efficiencies throughout the rest of the cycle and immediately before the claim is sent to the payer. In fact, providers are expected to invest up to  , as the need to crack down on denials grows. Submitting claims in the correct format is a common and frustrating challenge. Since each payer has different requirements and formatting preferences for claim forms, edits should be customized. A revenue cycle service provider can help you build these custom edits and check each claim line by line, so you can submit with confidence and avoid having to redo them later. Monitor and analyze your revenue cycle Regular analysis is essential to consistently improve denial rates. By monitoring your internal processes across a range of metrics, you can gain a holistic view of the entire revenue cycle to see where there are further opportunities to optimize performance and prevent denials. When you have confidence in the freshness and accuracy of your data – including patient access data, payer performance information and patient matching – you can make confident decisions about exactly what needs to happen to improve your claims denials. Learn more about how leveraging data-driven insights to tighten up your claims management systems and take proactive steps to find lost revenue.  

Over the last twenty years, American hospitals have provided more than $620 billion of uncompensated care for cases where no payment was made by a patient or insurer. This includes financial assistance, where hospitals provide care at a reduced cost for those unable to cover their full bill, and bad debt, where patients have not applied for financial assistance and cannot or will not pay their bill. Despite extensions to Medicaid coverage under the Affordable Care Act, the number of uninsured people in the United States is still approaching 30 million. For these often-vulnerable populations, safety-net hospitals provide essential care regardless of the patient’s ability to pay. But safety-net hospitals are themselves under increasing financial pressure, experiencing more than double the uncompensated care costs of other acute hospitals. And when safety-net hospitals are closed down or struggle to meet demand, nearby hospitals must cover the shortfall in care. It’s a problem for everyone. A Kellogg Insight report found that when more people are uninsured, hospitals bear the cost by providing uncompensated care to the tune of $900 for each additional uninsured patient. Craig Garthwaite, Assistant Professor of Strategy, describes hospitals as “insurers of last resort”: “People are still going to the emergency room and they are still receiving treatment – so the cost is still there. When governments do not provide health insurance, hospitals must effectively provide it instead.” Hospitals might respond to the burden of uncompensated care in three ways: shifting the cost of care to other payers, cutting the cost of services to all patients and removing unprofitable services, or accepting lower total profit margins. All have the potential to damage quality of care as well as revenue and workflow. But beyond these major systemic responses, there are steps providers can take to reduce their risk of unpaid care and optimize their existing revenue framework. Protect your revenue by finding missing coverage quickly The new reimbursement landscape forces providers to manage more self-pay patients, with high-deductible health plans and health savings accounts. This puts a lot more responsibility and stress on patients themselves, who may not be able to afford their co-payments. Uncovering missed or undisclosed insurance coverage is also costly and time-consuming for providers. Regardless of ability to pay, if your patients are wrongly classified as uninsured or as having only one insurance option, you’re likely to lose revenue. As the financial risk of uncompensated care continues to grow, there are important questions for healthcare executives to consider: How do you decrease your accounts receivable balances and self-pay write-offs? How do you increase cash flow from re-billed claims? Are you missing any opportunities to bill additional payers for services? Are you identifying coverage for emergency department inpatients in time to meet your notice of admission requirements? The answers boil down to having the right processes in place to discover which patients can and cannot afford to pay, ideally before they go through the billing system. When you know this, you can move quickly to direct them to alternative sources of funding. How to find insurance coverage to avoid bad debt and charity write-offs An automated coverage discovery solution could help you identify patient accounts that don’t have sufficient insurance coverage, without the expense and hassle of engaging a collections agency. This proactive software integrates with your revenue cycle to search government and commercial payers automatically, so you can find insurance coverage that may have been missed or forgotten. It relies on multiple data sources and reliable demographic information to detect any inaccurate financial classifications and alternative coverage options. It can also shed light on product usage, productivity and financial results, which may help you fine tune your revenue cycle in other ways. Murry Ford, Director of Revenue at Grady Health System explains how Coverage Discovery allows his team to identify an accurate coverage match for patients without the patient having to share this information: “We use Coverage Discovery when the patient is admitted… the system automatically attaches the coverage to the patient’s account. No one has to get involved – it’s touchless, it’s seamless, and it’s worked really well for us. It’s brought in revenue that we would not have identified otherwise.” Every dollar found in this way is a dollar you’re not writing off to bad debt, or spending on unnecessary patient collections and admin. Mike Simms, Vice President of Revenue Cycle at Cone Health says: “Coverage Discovery is wonderful... After every admission, the next day we get a file which gives us insurance on those that we’ve missed. We can add that insurance to the patient account and bill the insurance company. In the end it helps us resolve accounts in a timely manner. Since we’ve been using Coverage Discovery, we’ve received over $3 million in payments, and that’s more than a 300% ROI.” An automated solution like this can be plugged in immediately to handle unresolved accounts for you, resulting in faster and more accurate collections, greater patient satisfaction, and improved staff workflow – ultimately reducing your organization’s risk of uncompensated care. Learn more about how Coverage Discovery Manager works.

Consumers are bearing a bigger burden of healthcare costs than ever before. As the third largest payer behind Medicare and Medicaid, many patients find themselves struggling to foot the bill, with implications for hospitals and health systems. According to a TripleTree report published late last year, consumer payments will reach $608 billion by 2019, thanks to growing enrollments in high deductible health plans (HDHP), decreasing payer reimbursements, and increasingly personalized insurance plans that come at a premium. Almost half of those under the age of 65 are enrolled in an HDHP. These rising out-of-pocket payments can cast a long shadow on the patient's experience. The payment process is often stressful and confusing, and many are unable to pay without careful budgeting or some form of financial support. And for providers, the growing admin costs of chasing payments can create a serious cash-flow problem. A forward-looking, patient-centered approach to billing is critical. A good starting point for providers who want to reduce friction around payments, optimize revenue and build a positive relationship with consumers is to look at how data and technology can improve customer payment processes. You can do this in three ways: transparent pricing, patient billing tailored to each individual's financial situation, and simplified admin processes all provide greater clarity and reassurance for patients. Make patient billing easier​​​​​​​ with transparent pricing ​​​​New guidelines from the Centers for Medicare and Medicaid Services (CMS) call for hospitals to list chargemaster pricing on their websites, so consumers can make informed decisions about their treatment and plan accordingly. Unfortunately, the complexity of pricing structures and the way it's presented can still be very confusing for consumers. CMS Administrator Seema Verma tweeted that "While the information hospitals are posting now isn’t patient-specific, we still believe it is an important first step & sets the stage for private third parties to develop tools & resources that are more meaningful & actionable." Patients are encouraged to tell the CMS if they can't find pricing info on their hospital's website, using the hashtag #WheresThePrice. However, there’s been a lot of criticism that the CMS requirements do not meet consumer expectations. Health leaders should aim to provide consumers with accurate personalized estimates, using data-driven technology. Most healthcare organizations already have the basic data they need to generate estimates for basic services, including: claims data real-time eligibility and benefits information payer contracts charge description master (CDM) information. Riley Matthews, Senior Product Manager for the Patient Estimate Suite at Experian Health, says: "We're finding facilities are getting backlogged with calls while patients are trying to call in to speak to a live person to try to get an estimate... If a patient is comfortable understanding what they owe, they're going to be much more comfortable paying for their services." Giving patients accurate estimates upfront empowers them to understand their financial responsibility so they can make quicker, better decisions, and improve their overall experience. Personalize patient payment plans for a better patient experience The growth of consumerism in healthcare calls for a friendlier approach to the billing process, both for a better patient experience and to avoid non-payment. This means recognizing each patient as an individual with different needs and tailoring your offer at each stage of the revenue cycle. Some will be able to pay their whole bill up front, while others might need to spread it over a number of months, or seek support from a charity. Issuing the bill and hoping it gets paid isn't going to cut it – you'll be wasting time and money on repeated, unnecessary collection attempts. Instead, why not personalize each patient's payment plan based on their individual financial situation? No surprises for them, no missed payments for you. Insights from credit data can help you identify the best collection approach for each patient, so you can work with them to find financial assistance, set up payment plans in advance, or outsource payment to an appropriate co-payer. Simplify the admin process to improve patient collections These days, most of our life admin is done online, from banking to travel. Healthcare needs to do the same. You can make healthcare payments easier for your patients by giving them access to their accounts online, so they can manage it when it suits them. This is about making the revenue cycle as frictionless and consumer-friendly as possible. Data-driven technology makes it easy for patients to obtain accurate price estimates, set up or modify their payment plans, check their insurance details, combine payments to different providers, and facilitate mobile healthcare payments. Terry Manifesto, a Senior Director at El Camino Hospital, worked with Experian Health to allow patients to access and manage their data through a self-service portal: "We're providing a lot more estimates than we could before, because it's 24/7, on the go - a patient can use it from their mobile device, from their laptop, or their desktop." With healthcare consumerism and outcomes-based care trending upwards, the dynamics of healthcare finance are shifting. A collections approach based on compassion and simplification is the key to building trust and optimizing revenue at the same time.  

A recent Black Book survey of more than 500 healthcare networks revealed that hospitals in the U.S. have been painstakingly slow in adopting healthcare revenue cycle management (RCM) solutions. At the start of 2018, nearly 26 percent of hospitals had no viable solution in place, and 82 percent of them planned to make value-based reimbursement decisions without one.   For most hospitals, one of the biggest challenges in implementing RCM solutions is finding talent with the right skill set to handle RCM software difficulties. It’s a problem that even the largest healthcare delivery networks face and one that UCLA Health hospitals had to overcome. UCLA Health System Faculty Practice Group (UCLA FPG) employs more than 2,500 physicians with more than 220 primary and specialty practices.   Keeping up with payer contracts   In 2007, more than $4 million in revenue went uncollected at UCLA FPG. The group’s RCM pain points were typical of those in the industry. For example, the group was unable to keep track of over- and underpayments, which made it difficult to adhere to payer contracts. It was also difficult to manage appeals and track recovery as the volume of payer contracts grew and became increasingly more complex.   The difficulty UCLA FPG had in gathering and exporting information, in addition to the complexity and volume of contracts, left it with little negotiating power when dealing with payers. UCLA FPG's numbers continued to fluctuate until implementing Epic alongside Experian Health's Contract Manager.   Using this web-based solution, UCLA FPG has been able to automate and improve its revenue cycle due to the solution’s ability to continually monitor and update every payer contract. This has also helped the healthcare group stay compliant with all payer agreements by making it possible to catch errors faster.   Director of Revenue Integrity Measha Ford states: “We are able to catch Medicare overpayments faster with the contract management system. We recently integrated all our Medicare contracts into the system to have a lower risk of compliance issues since we only have 60 days to refund Medicare back once we identify an overpayment. Having this system, having that ability to load the contracts into the system to catch these potential risks, is very helpful.”   The UCLA network now has fewer administrative write-offs every year, faster AR collections, and reduced denials.   Experian Health's team maintains contract terms, fee schedules, and payment policies and makes sure every claim processed follows UCLA's contract terms. Online dashboards and reports help monitor reimbursement and reduce payment discrepancies through interactive graphs that expose source claim data and practice management system-specific data attributes.   Analyzing contracts before signing up   In addition to tracking and managing contracts, the group also knows exactly how a new contract or redefined contract terms will affect its bottom line. It has intel on real-world “what if” scenarios to provide insight into how various contract terms affect cash flow for the precise mix of services the group provides. It's also able to avoid unfavorable contract terms, as they are easily spotted through analysis.   Are health plans complying with your contract terms? Learn more about how we can help you find lost revenue with data-driven insight.  

Healthcare organizations have been forced to deal with billing challenges for so long that many might consider the struggle to simply be the price of doing business. Denied claims and contractual underpayments are regular occurrences in the payment cycle. And these issues can cause problems in the rest of the healthcare ecosystem when left unchecked. Fortunately, a robust claim scrubbing solution can reduce costs and speed up reimbursement. Healthcare billing costs can add up quickly. The estimated cost of billing- and insurance-related jobs at one large academic healthcare center ranged from $20 to $215 per patient visit, according to a study published in 2018. For years, the State of Franklin Healthcare Associates (SoFHA) was all too familiar with the challenges of the claims process. In 2010, the organization had to keep 12 full-time employees on its payroll devoted to the correction and resubmission of denied claims. When claims are denied, Crowe reports that it takes an average of 16.4 additional days for a hospital to receive payment. And those delayed payments are costly to healthcare organizations. Without the tools that enable a proactive approach, healthcare organizations' only option is to submit claims and then wait to correct the ones that are denied. SoFHA’s large network of 109 providers included a wide variety of specialties and services, from diagnostic imaging and internal medicine to OB/GYN and family practice. SoFHA needed a flexible presubmission claim scrubbing technology that would identify and correct errors before claims could be submitted. To overcome the obstacles in the claim submission process, SoFHA turned to Experian Health's Claim Scrubber. Claim Scrubber stood out to the group in two ways. The first was the price, as users pay a fixed monthly rate rather than pay for each transaction. The other highlight was the ability to build customized claim edits, which are available to all clients immediately when the tool is deployed. For Amanda Clear, SoFHA’s director of business services, that capability made all the difference. “With Claim Scrubber, I have the ability to go into the system and create my own edits,” Clear said. “Other systems either didn’t accommodate customized edits or required you to call, perhaps pay a fee, and go through a long process.” Plus, Claim Scrubber reduces demands on healthcare provider personnel because the tool comes with around 350 edits maintained by a dedicated content team. Payer-specific edits replace between 60 and 75 percent of an organization’s custom edits right away. Claim Scrubber ensures claims are correct and complete the first time they're submitted. Experian Health regularly updates its system with coding and payer changes. The tool adjusts for coding variances on claims submitted to Medicare, Medicaid, and private insurance companies. It reduces denials and drives down rebilling costs for healthcare organizations. With Claim Scrubber, SoFHA generated a clear return on investment, and the group was able to expedite accounts receivable by 13 percent. Perhaps even more telling was the reduction in full-time claim correction employees that accompanied the adoption of Claim Scrubber — a change that occurred in spite of a growing volume of claims. By auditing claims and spotting errors before submission, Claim Scrubber can ease the burden of claims denials and allow healthcare providers to instead focus on their job of providing the highest-quality patient care. --- Learn more about how we can help you ensure all claims are complete and accurate before submission to the appropriate payer or clearinghouse.  

Healthcare providers should be able to focus on what's important: their patients and the care they need. However, providers and their staff must spend much of their time on administrative tasks. A study by AMA Prior Authorization revealed that providers are spending two business days per week just completing prior authorizations. That doesn't even account for other administrative tasks. Meanwhile, providers rely on more payers and plans than ever before, which is often tied to their clinical performance, and patients are becoming increasingly more responsible for the cost of their care. This is leading to an increase in operating losses per physician of 17.5 percent of net revenue in 2017. Providers must prioritize their revenue cycle efficiency if they want to remain financially solvent in the ever-shifting healthcare field. To safeguard its revenue, Schneck Medical Center in Indiana, the only hospital serving four counties, wanted a way to optimize claims follow-up by identifying and targeting the claims needing attention as quickly as possible. This was especially important because an estimated 10 percent of the population lacks insurance and 13 percent lives in poverty in the primary county the medical center serves. Schneck's goals were to: Ensure denials did not exceed 3 percent of net patient revenue. Achieve the estimated total net preventable denials of $3.2 million or a 2 percent increase to operating margin. Reduce denials by confirming patient insurance eligibility, verifying medical necessity, and obtaining prior authorization when appropriate. Makenzie Smith, director of patient financial services at Schneck, said that industry pressures to reduce healthcare expenses and provide a better patient experience are what drove the healthcare organization to look at the revenue cycle technologies and processes it had in place. A better denials management system The denial management process can be cumbersome, especially for community hospitals like Schneck. It takes up too many resources and far too much time. Schneck was looking for better denial analysis reporting and automation software so it could more effectively manage denials and significantly increase collections. The organization's search led to Experian Health's automated approach to tracking the root causes of denials and identifying the trends in order to improve procedures. The software tool provided a comprehensive solution and allowed Schneck to optimize its claims workflow with remittance detail and analytics. It now helps the medical center identify denials, holds, suspends, and zero pays and uses electronic remittance advice and claim status transactions to identify appeals won or lost with payers. This allows Schneck to identify and target the claims that require immediate attention. The payoff With executive leadership buy-in and support, Schneck created a new, better process for claims denial management by: Reviewing preventable denials with customized queues in real time. Identifying directors with staff responsible for checking a patient's benefits and obtaining prior authorizations. Reviewing all denials over $500 in the revenue cycle department. Establishing a schedule for reviewing denials each month. Schneck's new streamlined process and real-time visibility into denials data has allowed staffers to work on denials more efficiently. The ability to link denials to a specific staff member in a specific department has further streamlined the process. The relationship between the front and back office has improved because both sides have achieved a better awareness of processes. With the right denial analysis and automation, healthcare organizations like Schneck can manage denials effectively and increase collections significantly.

It's no secret that claim denials cost healthcare organizations. They take about 16 more days to pay out than claims that have not been denied. On average, this delay in payment equates to one percent of a healthcare organization’s cost structure.   Final claim denials — or claims in which the payer never pays the provider — lowers a typical hospital’s annual net revenue by 1.9 percent. These tack on additional administrative costs because of the work it takes to close them.   The good news is that 76 percent of claim denials are eventually paid off — but the staff time it takes to get the payments can be costly.   Claims roadblocks   Experian Health recently worked with a large healthcare organization that manages more than 200,000 claims per month, which exceeds $1 billion in claims dollars. The organization has almost 50 hospitals in its network, as well as urgent care and cancer care centers, which creates a large number of transactions and claims to process. This includes Medicare, Medicaid, private insurance, worker's compensation, managed care, and more.   Before partnering with Experian Health, a number of errors were leading to denied claims, including discharge-not-final-billed errors, claims errors, stop bills, late charges, clearinghouse edits, and other factors that created roadblocks. But claims automation helped turn things around.   Automation reduces errors   Automation provides benefits to healthcare organizations and patients because it speeds up evaluation, ensures correct and timely billing, and reduces the number of manual touches needed for each claim.   According to the Council for Affordable Quality Healthcare, manual processes slow down claim reimbursement. People take an average of four minutes to process claims, but automation reduces this to three minutes.   Although a minute doesn't sound like much, it translates to thousands of hours saved for a healthcare organization that processes 200,000 claims each month. Automation also frees up time for billing teams to focus on more pressing tasks.   How organizations can benefit   By automating, this healthcare organization could ensure clean claims by utilizing an expansive library of national payer edits and implementing custom edits. This eased the follow-up process because teams had detailed insight into claims status, an analysis of denial reasons to efficiently process them, and automated workflow and payment posting to handle splits and contractual adjustments.   One of the biggest reasons this healthcare organization partnered with Experian Health was the ease of implementation with its medical records system, Epic. For example, ClaimSource easily loaded customized edits and the edits library into Epic, tracked and corrected claims, found and repaired issues with the system build, and created opportunities for cross-training and centralized reporting.   Long-lasting results   Through this automated process, the healthcare organization now has detailed insight into its claims management process and can monitor rejections data, review effectiveness, and find ideas for even more system automation.   Through its partnership with Experian Health, this healthcare organization has improved its claims metrics across the board. It improved its acceptance rate by 10 percent, and it became an Epic top performer for claims acceptance, averaging a 99 percent acceptance rate. It has also increased its clean, paid claims percentage by over 10 percent.   Start automating to streamline your claims process.

Healthcare runs on revenue, and claims denials can put a big dent into the budgets of healthcare providers — between 5 and 10 percent of claims submitted by healthcare providers are denied. This adds up to billions ­of lost dollars each year for providers in the U.S.   The good news? Ninety percent of claims denials are preventable when healthcare providers automate revenue cycle functions. In fact, providers could gain an estimated $9.5 billion by automating the claims management processes. And money isn’t the only thing to be saved — companies could also have more time to work on other processes.   The problems facing one Oregon healthcare provider   Monitoring claims and cash flow is difficult for any healthcare organization, as the staff at Summit Medical Group Oregon — Bend Memorial Clinic (BMC) knows. Summit Medical Group Oregon – BMC found its team consistently waiting for payer response, which often forced its overall operations to drag.   After 30 to 45 days of submitting claims, if Summit Medical Group Oregon – BMC did not receive payment, staff members would have to reach out to payers to determine whether they had received the claim. They also had to determine whether the claim was in the process of adjudication, as well as any other steps the staff should take in order to get the claim processed, according to Summit Medical Group Oregon – BMC business analyst Sean Schlappy.   These manual processes not only create lags in claims reimbursements, but also take up a lot of staff time. The Council for Affordable Quality Healthcare found that processing claims manually takes an average of four minutes, while processing automated payments takes an average of three minutes. So Summit Medical Group Oregon – BMC decided to implement software solutions to improve acceptance rates.   The tools used for improvement   One product Summit Medical Group Oregon – BMC implemented was Claim Scrubber, which ensures all claims submitted are accurate before they're sent to the payer. Because it can be integrated with most practice management systems, this service allows employees to set up notifications in the healthcare provider's work queue. It also provides detailed dashboards and reports to quickly recognize trends to improve medical coding and reimbursement rates.   Summit Medical Group Oregon – BMC additionally turned to Enhanced Claim Status, which provides employees with status requests based on the payer’s adjudication time frame, improves productivity, and ensures timely and accurate payments. This tool reduces the amount of time staff members must spend interacting with the payer, and it generates work lists of claims with actionable data.   By transitioning most of its coverage information upstream, Summit Medical Group Oregon – BMC was able to obtain more accurate data during the initial patient introduction and registration. Using this technology, Summit Medical Group Oregon – BMC also improved the patient experience.   Using technology for clean claims   After implementing Enhanced Claim Status in conjunction with other services from Experian Health, Summit Medical Group Oregon – BMC gained a 15 percent reduction in accounts receivable days and volume. And the healthcare organization now has a 92 percent primary clean claims rate, and its claims denial rate has dropped to 7 percent.   Integrating several tools is helping Summit Medical Group Oregon – BMC in the long term, Schlappy says. Summit Medical Group Oregon – BMC has increased payment processing and reduced claims denials, and, most importantly, it's producing cleaner charges.