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It’s only natural to want to be fairly, fully and quickly reimbursed for services – it’s the basic foundation of business. Yet only in healthcare does attaining this basic transactional norm become challenging. Healthcare providers must be vigilant at all stages in the revenue cycle to ensure the amount they receive is timely and accurate. Achieving this deceptively simple goal is dependent upon insight – the ability to discern the true nature of a situation and to respond appropriately. Applying insight at critical points in the claims lifecycle can make a marked difference in reducing denials and accelerating payment.  The foundation of a successful claims management strategy begins with contract management, where advanced analytics and data-driven insight can help you quickly and easily pinpoint payment variances and validate reimbursement accuracy for each of your third-party payers. Ensuring compliance with contract terms allows you to identify recurring issues so they can be promptly addressed, while providing the ability to strategically evaluate overall contract performance. Once you achieve visibility of the contract process, you can apply those findings to other areas, such as claim scrubbing. Boosting the first-time pass through rate eliminates costly, time-consuming rework and speeds reimbursement. A strong claims scrubbing approach involves taking time, prior to submission to the appropriate payer or clearinghouse, to ensure the claim is complete, accurate and meets individual payer requirements. Once the claim is submitted, it’s not a matter of “out of sight, out of mind.” Tracking claim status early in the adjudication process – rather than waiting for a denial to appear on your desk – helps improve cash flow and maintain a healthy revenue cycle. An online payer portal provides instant insight into the status of each claim and gives you the ability to determine if a claim is lost, denied, pending or being returned. Regardless of how well you scrub claims before submission, it’s likely that a certain percentage will be denied. You can optimize and accelerate payments by quickly and efficiently identifying denied claims for analysis and re-submission. Use technology to ensure denied claims aren’t overlooked and streamline the workflow associated with claims management. Finally, taking a comprehensive look at all pending claims and denials allows you to prioritize claims and denials so that your staff can work the highest impact accounts first to improve efficiency and increase revenues.  Advanced technology that provides insight into contracts, payer requirements, claims status and denials holds the key to reducing the claims processing errors that add an estimated $1.5 billion in unnecessary administrative costs to the nation’s health system. Few healthcare organizations can afford to receive less than their fair reimbursement for the care they provide. By implementing a strategic approach that grants insight into each component of the process, healthcare organizations can bolster the bottom line and streamline efficiencies along the way. To learn more about how to turn these strategies into tangible results, register for our Dec. 3 Webinar, “5 Ways to Accelerate Your Claims Payments."

There’s a unique dichotomy in healthcare that’s not found in other service industries. For example, when you go out to eat at a restaurant, you don’t expect the server to ask you to pay before the meal is served. Conversely, you also don’t expect to walk out of the restaurant after the meal without paying. However, if you have ever ordered the special of the day and been shocked when the check arrives and the item costs twice as much as other menu items, you can certainly understand the patient’s viewpoint. How can a patient make informed choices about his or her healthcare without knowing the cost? Price transparency – one of today’s hottest healthcare topics – offers significant benefits to both providers and patients, including: Empowering the patient to make well-informed decisions on healthcare treatments Improving patient satisfaction and involvement with their care management Allowing appropriate upfront collections based on realistic estimates Serving as a foundation for establishing payment plans or seeking charity The difficulty of providing a reliable estimate has hindered efforts to collect from patients at the point of service, when they are most likely to pay. In order for the estimate to be relevant and timely, it must bring together financial data from the chargemaster, claims history and payer contract terms, and integrate that with the patient’s insurance benefits. Thankfully, this is a task that is ideally suited to technology. Not only can you use a payment estimator to quickly and easily create a targeted estimate, healthcare organizations can also eliminate the need to manually update price lists, as well as remove guesswork and tedious searches through potentially outdated patient information. An estimator is the base of an effective upfront collections strategy, and is complemented by the ability to determine if a patient is eligible for charity care in addition to their propensity to pay. An additional complement is to streamline the payment process by facilitating the collection of patient open balances through eChecking, signature debit, credit, recurring billing, cash, check or money orders. The ability to create price transparency that is applicable to each patient’s individual situation is critical to a healthcare organization’s financial performance.

Real-time information and advanced data and analytics help identify the most effective collections approach based upon each patient’s financial situation