Get Healthcare Revenue Moving Again

How Automated Payer Follow-up Jumpstarts a Stagnant Claims Cycle

Intentional or not, the current healthcare landscape seems designed to reduce the revenue physicians and hospitals earn per patient, no matter how high in quality the care or the cost in labor and supplies to deliver it. In a parallel development, the reimbursement process for this care is eroding the financial health of providers.

Claims remittances commonly take up to 40 days or longer to arrive, leaving providers with few options other than to passively wait or pursue costly fixes such as staffing up internally or hiring third parties to follow up with payers, or communicate with payers via decades-old electronic data interchange (EDI).

The financial toll this is taking is enormous. In 2012, the nation’s healthcare providers spent a cumulative $471 billion on billing and insurance-related activities; money that could otherwise have been redirected to patient care. This inefficient reimbursement climate isn’t just threatening financial performance for individual hospitals and providers. It’s draining the entire healthcare system.

In search of more affordable and effective solutions to payment delays, many provider organizations are automating the payer follow-up process. This white paper examines the claims status automation trend in depth to reveal a clear picture of the technology that is helping providers recapture a timely and efficient billing cycle.

The key to speeding up claim payments is knowing soon after submission which claims are going to get denied, either partially or fully. In the absence of this information, providers spend inordinate amounts of time chasing after all claims—time that could instead be spent on remediating the ones slated for denial status. The answer is exception-based claims processing, which translates into a powerfully productive workday for claims remediation specialists.

A significant benefit of automated claims follow up technology is that root causes of denials quickly become very clear. This helps providers adopt any number of improvements in multiple departments. Further, the right people are now put to work exclusively on problem claims—turning your best employees into the true insurance coverage specialists they are.

Providers can also better predict cash flow, know how much to keep in reserve for contractual adjustments and make other financial decisions that were previously constrained by lack of insight into projected revenue.

The idea to use website harvesting tools isn’t new. But taking that rich data and applying rules to create smart workflow triggers is—along with replicating these processes among hundreds of payers at once. This is automated payer follow up technology designed to retrieve and leverage data at a massive commercial scale.

Download the datasheet

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