A complex payer mix and highly specialized claims requirements can lead to an uptick in denials, but a customized editing approach can reduce claims submission errors and streamline the billing process.
Andrew Ray, Director of Physician Revenue Operations, Stanford Children's Hospital (Palo Alto, Calif.): The insurance market in California is complicated, and we're a large organization that delivers sophisticated, highly specialized care. This combination presented challenges when it came to getting procedures paid. To help our claims and payment posting teams become more efficient, we created a customized claims editing approach so staff could include the necessary edits, rules and fields all in one place. All of these improvements decreased the volume of reworked claims resulting in a 20 percent increase in reimbursement within the first 45 days of the date of service.
If you would like to share your RCM best practices, please email Carrie Pallardy at cpallardy@beckershealthcare.com to be featured in the "RCM tip of the day" series.