Fix your claims submission process with internal assessments

Although the compliance deadline for ICD-10 has been moved back to Oct. 1, 2015, much of the code set's regulations remain in place. Physicians still have to train their staff to provide more detailed clinical documentation for diagnoses and run tests to ensure that their practices are capable of managing the larger number of codes available in ICD-10.

High cost of denial
In the beginning, small amounts of rejected claims might have a minimal effect on a practice's bottom line. However, when claims are continuously denied by payers, it can drastically impact the revenue cycle. According to the Medical Group Management Association, the average claim denial can cost between $25 and $30 each.

Because of this, it's important that healthcare providers working with information technology, such as medical billing software, utilize the products at their disposal to check patients' insurance eligibility before an appointment. By reviewing this information early on, physicians can ensure that an individual's insurance provider covers certain aspects of the medical visit. From there, patients can be informed of the possible out-of-pocket costs associated with specific services, PowerYourPractice explained.

Train staff for success
EHRIntelligence reported that improving the claims submission and reimbursement process begins and ends with the current state of the practice. The internal staff - nurses, doctors, administrative assistants - all need to be trained in order to succeed. From pre-registration with insurance information to better billing services, fixing broken submissions starts with self-examination.

"When you compartmentalize your practice or your hospital across these five areas, you're able to address within each of these components what is working and not working, what are the industry standards, where are your peers compared to where you are, and what you need to do to get to the next stage and then beyond that," said Nalin Jain, delivery director of advisory services at CTG Health Solutions, quoted by EHRIntelligence.

In addition to pre-registration and billing services, Jain suggested that healthcare organizations take the following components into account as well: process of care, clinical documentation and administrative services. By focusing on the financial, technical and operational aspects of the practice, providers can begin to see the big picture of their revenue cycle.

The financial side might be the most important, as it looks over the accounts receivable department and its analysis on collection rates and denial management. The patient-provider interaction is taken into account on the technical side, which considers the systems and applications involved in the relationship.

The roadmap to profitability
The entire internal assessment can last for a few months depending on the size of the practice. While it might call for an increase in resources, once the review is finished, practices can begin to construct a roadmap to measure and improve revenue cycle management.

Providers should look to tackle simple tasks first before moving on to more difficult activities. Doing so can show that there's room for improvement within the organization that would benefit stakeholders. The added time for ICD-10 should make claims submission management a much easier aspect of healthcare.

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Kevin McCarthy's picture

Kevin McCarthy

Industry News Editor

An avid traveler and news junkie, Kevin covers a range of topics from healthcare technology to policy and regulations. As a former journalism student, he enjoys finding stories relevant to small practices and is passionate about keeping them informed. Before joining NueMD, Kevin worked for Turner Broadcasting as a Programming Intern where he conducted legal research and contributed to editorial content development. He received his bachelor's degree in Communication from Kennesaw State University and currently serves as the Industry News Editor at NueMD.

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