With all the information that can be found searching the internet and reading newsletters, industry publications, and journals, there is definitely no shortage of advice on best practices to speed up reimbursements from payers. But even with all this information floating around, there’s still some being missed. Namely, the importance of automating claim status workflow.
According to a 2018 CAQH Index Report, if healthcare organizations were able to effectively automate administrative transactions, they could generate nearly $1.7 billion in savings annually.¹
Thanks to their high number of administrative transactions, healthcare organizations experience the strongest ROI after automating benefit verification, prior authorizations, and claim status inquiries. But providers have been reluctant to adopt the use of such technologies. It seems that many are in the dark about how much money unnecessary account touches are costing their organizations. Just by automating claim status inquiries, organizations could save as much as $4.35 per transaction.¹
Healthcare organizations understand the importance of submitting clean claims and do their best to make good use of the software designed to review and edit claims prior to submission. But over 5% of claims will still not be paid on the first pass, and payers can take anywhere from 14-60 days (or more!) to resolve troublesome claims.
The problem isn’t just submission. It’s how you do your follow-up.
Payers’ use of auto-adjudication has helped, but it’s nowhere near solving the problem. According to data from America’s Health Insurance Plans, the overall rate of auto-adjudication by payers is below 80%. This means that many claims still require manual intervention during at least one point of their life cycle. The challenge then becomes quickly determining which claims need the attention of the system’s limited staff. A tall order, to say the least.
Even the largest integrated delivery networks experience challenges when attempting to hire enough professionals to scale such a highly manual process into a comprehensive and timely claim status program. Hospitals process tens of thousands of claims per month. That’s hundreds of claims per employee work-list. And millions in missed revenue for the average-sized hospital.
Two Ways to Ensure You Get Your Hands on That Cash:
1. Look into exception-based workflow. This approach leverages automated web bots that query, retrieve, and normalize detailed claim status data from payer websites days (or weeks) before the provider would otherwise receive it. Automating this process removes approved pending claims from the queue, which is often up to 80% of the workload.
While this automation rate alone creates huge leaps in productivity, it doesn’t stop there. Automation simplifies the process of correcting denied claims in preparation for resubmission.
How? Remember those web bots we mentioned earlier? They scour payer websites for claims data beyond what’s available in standard EDI and return with a detailed explanation of the reason for denial, leaving no additional research or payer follow-up. Unlike with the generic response from EDI, your staff will know exactly what they need to do to remediate a claim.
To further streamline processes, claims marked for denial are routed to the appropriate work-list according to your organization’s workflow. Staff can then become specialized by payer, denial type, etc. to only work on claims they have experience handling.
2 . Cut out outsourced claim status follow-up entirely. Experienced, professional medical billers ensure that claims are accurately submitted in a timely manner. That’s their job. The sole purpose of claim outsourcers is to chase tough claims that need remediation, but if your staff is armed with the exact reason for denial, you won’t need to outsource.
Robots in healthcare won’t replace human workers. But bots with workflow orchestration can be a key tool for reducing the burden of mundane, common tasks (read: claim status inquiry). Hiring more staff, which can already account for up to 60% of a hospital’s operating expenses, isn’t the solution to your problems.
By automating claim status workflow, you can follow-up and remediate a denied claim faster, accelerating your cash flow and capturing revenue that otherwise might be written off to timely filing.
Accelerating automation adoption in the business office has the potential to transform claim status workflow far more quickly and cost effectively than any manual best practice. To accelerate cash flow, business offices must do more with less, making sure employees are supported by tools and technologies that make their jobs easier.
Get started automating your claim status workflow with ClaimStatusPlus by Recondo.