Rx for rejected claims: Automate patient registration
You don't have to be a political pundit to foresee that 2017 could be a tough year for healthcare administrators. With Congress making moves to repeal the Affordable Care Act even before Inauguration Day, it seems likely that major changes are on the way for health insurance infrastructure and mandates.
As the healthcare system responds to new requirements and mechanisms, office and billing staff will feel the impact. While the specifics are unknown, one outcome seems certain: providers will feel even more pressure on their bottom line.
The healthcare industry as a whole is under relentless pressure to increase efficiency and revenue in an increasingly complex and competitive system. After years of rising premiums, high deductibles, and frustrating interactions with insurance companies, consumers are maxed out and concerned about pending changes. To ride out the rough seas ahead, providers have to be shipshape; a renewed focus on optimizing operations and deploying automated technology solutions will ensure smoother sailing.
For providers, rejected claims are a significant drag on bottom lines and productivity. While the Academy of Family Physicians (AAFP) recommends providers aim for a two percent billing denial benchmark, the industry average is closer to 10 percent. The California Nurses Association found in 2011 that the state's insurers denied 26 percent of all claims the previous year. Similarly, the National Health Insurer Report Card shows Council for Affordable Quality Healthcare (CAQH) has estimated at rates ranging from 11-27 percent. Experts are quick to point out that most of these denials are not due to eligibility, or even to coding errors. In fact, many are denied simply due to inaccurate or incomplete patient information: basic demographics, Social Security numbers, insurance plan numbers, etc. These experts recommend basic measures providers can take to reduce rejected claims, including automation, staff training, and improved administrative processes.
Rejected claims cost providers both time and money; reworking and resubmitting a claim requires many more staff hours than submitting a clean claim the first time. Many offices are so short staffed, they are unable to resubmit claims, or fail to do so within the allowed time frame—essentially leaving money on the table. Even when claims are successfully resubmitted, the additional time and work protracts the revenue cycle, disrupts cash flow, and eats into profit margins.
The initial, and arguably most essential, step in reducing rejected claims is to accurately and efficiently enter patient data into the provider's records system. Advanced ID scanning and verification solutions increase the speed and accuracy of data entry, and are key to streamlined customer service. Less time spent manually entering data means more time to focus on the patient and their needs. Patients are happy to skip waiting in line and filling out clipboards full of repetitive paperwork.
Electronic claims submissions have helped reduce the time between a patient's appointment and the insurance company's receipt of claim for that service. The efficiency of electronic processing, of course, still depends on the quality of data initially fed into the system. Many practices are deploying ID scanning and verification technologies to ensure better data capture. Automated patient registration processes self-service kiosks or desktop or mobile card scanners can be integrated with EHR systems and policy databases to ensure that patient data is up to date and verified. Such systems significantly reduce errors in patient records and claims submissions while saving hundreds of keystrokes per per patient intake.
These scan-and-verify systems also help combat the growing problem of identity theft and insurance fraud, issues that could intensify if the pending ACA repeal-and-replace transition does not roll out as smoothly as planned. There will likely be some degree of upheaval as insurance providers opt in or out of the new system; employers and individuals may change insurance plans more frequently as the dust settles. Healthcare providers should be prepared to take such administrative changes in stride so that they will have time to focus on responding to more substantive regulatory or funding changes.
Barring unforeseen consequences of the ACA repeal, the numbers of insured Americans will continue to increase, leading to higher patient volumes at hospitals, clinics, and physicians' offices. Given that more people are paying out of pocket for routine services due to high deductibles, they are more likely to choose providers based on price and value. In other words, the quality of their care and their experience as a customer will play a bigger role, compelling providers to control costs and optimize services by following best practices from other consumer-driven businesses. This includes the use of cloud platforms and services to automate, record, and analyze patient data in order to improve treatment, comply with regulations, integrate with external provider and insurance systems, manage revenue cycles, and identify problem areas. The Council for Affordable Quality Healthcare (CAQH) has estimated that full adoption of electronic transactions (in other words, reducing manual business processes) could save U.S. healthcare billions of dollars per year and millions of labor hours per week.
For the near-to-midterm, the business of providing care is not going to get easier for healthcare administrators. In a dynamic industry buffeted by government mandates, insurance company machinations, and consumer demands, sustaining cash flow and maximizing revenue are paramount to survival and success. Market pressures leave little room for error, especially for the kinds of avoidable errors that lead to rejected claims. You can prepare for the coming changes by perfecting basic administrative procedures: collect accurate, verified patient data and leverage that as you take your business to the next level, come what may.
Bruce Ackerman is Executive VP of Global Sales for Acuant, the leading provider of intelligent data capture and authentication solutions.
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