Understanding the value of automating healthcare claims
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Inovalon
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In today’s healthcare environment, provider organizations of all types are striving to deliver the best care for their patients while working to stay ahead of complex revenue cycle management tasks. My team and I have a unique view into the challenges of revenue cycles and the opportunities to improve efficiencies with the right technology. We’ve witnessed how automated healthcare claims management workflows can unburden billing staff, reduce A/R days, and help secure more complete reimbursements. Let’s talk about some of today’s most common revenue cycle challenges – and how automated healthcare claims management can help resolve them.
Common healthcare billing challenges in 2023
Healthcare organizations relying on manual claims submission, edits, and reworks face multiple challenges to keep their revenue cycles moving, including:
Billing staff challenges
The healthcare industry is facing a nationwide staffing shortage. In September 2022, 58% of providers responding to an MGMA survey reported staffing as their largest challenge heading into 2023. Furthermore, according to the CAQH Index, providers spent more time and money on administrative tasks last year due to an industry-wide increase in transactions.
High turnover rates present multiple challenges. In the short term, providers are faced with staff shortages. Over the mid- and long term, departing billing staff take their knowledge of the nuances of billing processes with them – resulting in increased time to train and onboard employees and decreased efficiency. Modernized claims submission processes not only streamline billing processes and fight burnout, but they also help mitigate the risk of processes breaking down when future staff move on or retire.
A/R delays and incomplete reimbursements
How often does your organization see denied claims due to improper coding? More and more, the alignment between billing staff and clinical staff plays a key role in ensuring maximum reimbursements. As reimbursement models change and new models are adopted (e.g., value-based care), both teams should be working together to ensure their workflows are not conflicting leading to claims denials
Coding errors due to lack of alignment between teams can lead to an increase in delayed and incomplete reimbursements. According to Healthcare Finance News, audits have uncovered around $12 million in Medicare Advantage overpayments from 2020 to 2022, with costs ranging between $10 and $5,888 per patient.
Denials due to incomplete or inaccurate patient information
Whether due to human error or outdated patient information, manually entering and submitting medical claims often results in long A/R delays and increased denial rates. Denied claims must be reworked to achieve reimbursements, which can cost providers anywhere from $25 to $181 per claim. They also take up more billing staff time without guaranteeing that the claims will be accepted on the second (or third) submission.
Issues with legislative compliance
Healthcare legislation is constantly evolving. Recently, we’ve seen the No Surprises Act, which prohibits providers and sites of care from billing patients more than what they would pay for in-network cost-sharing for surprise bills, such as emergency services and post-emergency stabilization. Complying with emerging legislation is a challenge, and it’s made more difficult when providers and sites of care don’t have support or technology to help them stay up to date on the latest regulatory changes.
4 key benefits of automated healthcare claims
Implementing automated healthcare claims software can help simplify every part of the revenue cycle, from account creation to reimbursements. With the right technology, providers can:
Enhance operational efficiency
Wasteful administrative spending costs the healthcare industry $570 billion per year. Streamlining the claims submission process can save your organization revenue and unburden billing staff, cutting down on administrative costs and reducing staffing challenges around employee turnover. Likewise, with less burden on billers, providers can cut down on billing staff requirements, thereby addressing challenges around finding and retaining new staff members.
Accelerate A/R days
Automated claims management software is a godsend to a New York psychotherapist who operates a single-provider practice. “I know I can expect to be paid consistently and quickly. I know that the claims are correct and accurate, and the platform just works really well and really quickly. Whenever I have delays, it’s almost always because of something on the payer’s end.”
Automated healthcare claims, paired with advanced claims scrubbing software and supportive clearinghouse partners significantly reduce the chances of human error on claims submissions. As a result, providers that embrace automation and end-to-end RCM services may see significant decreases in denial rates. With more claims accepted on the first pass and fewer denials, providers can receive up to 95% of their reimbursements in 20 days or fewer.1
Achieve more complete reimbursements
Along with shorter A/R days, automated claims management processes can also help providers reduce write-offs and achieve more complete reimbursements. BAYADA Home Health Care saw a $250,000 return on investment in its first year of implementing Inovalon’s RCM solutions.
Advanced insurance discovery tools can help billers quickly identify all applicable payers for each patient. Billing all of the correct payers the first time and every time can have a significant positive impact on providers’ bottom line. By automating insurance discovery processes, Gulf Coast Collection Bureau saw a double-digit increase in insurance collections while simplifying RCM workflows. Gulf Coast COO Marie St. James commented, “Our agents simply log in and choose the categories they want to see. They can quickly determine the probability of a particular insurance being for a specific person.”
Improve the patient experience
Patients appreciate streamlined check-ins and predictable billing. Automated eligibility verifications streamline the check-in process by reducing or eliminating the need for time-consuming paperwork and manual checks. Further, the same automated processes that enhance billing efficiency and decrease denials also reduce instances of billing patients for denied claims. This helps providers better comply with regulations like the No Surprises Act while improving the patient experience.
How to automate healthcare claims
Transitioning from manual RCM tasks to automated healthcare claims management processes may seem like a daunting task. However, this move can significantly streamline your revenue cycle workflows, decrease the burden on billing staff, improve morale, and enhance the patient experience. Let’s walk through what it looks like to go from entering claims by hand to automating your revenue cycle.
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- Automate claims submissions. Start by reducing repetitive tasks like manual claims submissions. This will enhance business office efficiency and help reduce denials.
- Eliminate manual eligibility verifications. Save patients time and keep appointments running on schedule by automating eligibility checks and enabling batch eligibility verifications.
- Automate insurance discovery tasks. Identify all applicable payers and achieve more complete reimbursements without overburdening billing staff.
- Implement data visualization technology. Finally, allow your organization to identify better-informed business decisions by implementing advanced data visualization and analytics tools. This will help your organization identify and address trending errors and areas for improvement.
Improve the patient experience with claims management solutions from Inovalon
The processes and requirements for healthcare claims submissions are constantly evolving. Staying up to date on the latest legislation and standards while manually submitting claims can feel impossible. Plus, manual claims processes increase the likelihood for human error on claims submissions, which can lead to more denied claims, longer A/R days, and lower reimbursements. With automated healthcare claims, providers and healthcare organizations can streamline RCM processes, from account creation to eligibility verification, payment, and reimbursement.
Request a consultation with an RCM expert today to find out how Inovalon helps healthcare organizations get out of the revenue rut to keep their revenue cycles moving in the right direction.
Source:
- Inovalon internal reporting. Average of customer results, accessed August 2022.
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