3 ways to use claims analytics to thrive as an independent practice

Managing an independent practice is becoming increasingly difficult in the face of growing administrative, regulatory, and financial burdens.

According to an American Hospital Association survey, an overwhelming 94% of physicians say these factors have made it more difficult to open a practice, while 81% said commercial insurer policies interfered with their ability to practice medicine.

As a result, more physicians are turning to hospitals, health systems, and corporate entities to handle these challenges so they can direct more of their focus to clinical care.

Between 2019 and 2021, 108,000 physicians became employees of hospitals or corporate groups, representing a 19% increase. Hospital and corporate entities acquired 36,200 practices during that time frame.

So, what’s keeping you independent? There are a number of great reasons to maintain your autonomy, like having more flexibility, higher earning potential, unlimited growth opportunity, and the ability to focus on caring for patients rather than abiding by rigid corporate policies, just to name a few.

If you want to remain physician-owned for the long term, however, you need business strategies that are built for the precarious landscape we’re currently living in. Here are three steps to alleviate some of the biggest difficulties associated with being an independent practice owner.

3 ways intelligent claims analytics benefit independent practices

1. Solve administrative problems with innovation

Relying on slow, outdated systems to manage administrative tasks compounds the impact of staffing challenges and labor shortages that can threaten your practice. On the other hand, cutting-edge claims management systems are designed to maximize efficiency. Revenue cycle management software reduces the number of steps in the claims creation process and makes essential tasks like eligibility verification an automatic part of the workflow.

With a solution that offers true integration, staff can work commercial and government claims from a single interface with user-friendly dashboards, eliminating the back-and-forth app jumping that legacy technology often requires. With claims data analytics built into the system, team members are able to better understand their impact on revenue and take ownership of their performance.

Automated claims management allows staff to spend less time on each claim, freeing up resources for other duties and easing staffing headaches. Reducing manual touchpoints also prevents errors that can slow down reimbursements.

2. Adopt denial management strategies for the current landscape

As an independent practice, you have a major advantage over the massive corporate groups: adaptability. Medical offices with five to ten physicians can make changes much faster than health systems with thousands of employees, and this agility can be a great asset in maintaining your autonomy.

The payer landscape has changed rapidly in the last several years, and if you’re like most physicians, you’re seeing climbing denial rates and tightening reimbursements. A recent analysis of denials from Affordable Care Act plans found that on average, insurers denied 17% of in-network claims. Seventeen of the 162 insurers in the study denied more than 30% of claims.

An unprecedented denial situation calls for ingenious denial management tactics.

The first part of the equation is your response to denials. An all-payer clearinghouse offers automated claims correction tools that make recouping revenue fast and straightforward. Clear error messaging and edit guidance streamline the process of resubmission so you can turn more of your denials into paid claims.

The second part of the equation is prevention — making sure fewer denials occur in the first place. By using an intelligent insurance claims analytics solution, you can gain deep insights into the root cause of denials specific to each payer and claim type. Armed with this knowledge, it’s easy to set up custom business rules that proactively prevent errors and provide additional staff training as needed.

3. Fully leverage your data

As the leader of an independent practice, analyzing spreadsheets probably isn’t high on your list of daily priorities. The good news is that it doesn’t have to be. With a data analytics tool that gives you end-to-end revenue cycle visibility, it’s simple to review your financial performance in real time with just a few clicks and pinpoint problem areas that need further attention.

With integrated claim analytics data, you can unlock payer, biller, and claim specific insights to increase staff productivity and improve your first pass yield. And, by eliminating manual reporting, you’ll save additional labor hours and the expense that comes with them.

Improve your claims management with Inovalon solutions

Take action on the three steps above with Claims Management Pro and RCM Intelligence, a technology stack designed by revenue cycle experts to help private practices thrive. With access to superior customer service and specialized denial management expertise, exceptional RCM performance — including an average 15% improvement in cash flow¹ and first pass yield of 93%² — is within reach.

Learn more about Claims Management Pro and RCM Intelligence.

Sources:

1. Inovalon internal reporting. Average of customer results, February 2023
2. Inovalon internal reporting. Average of customer results, April 2023

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