How Emergency Medicine Billers Can Break the Claim Denial and Rejection Cycle

In the pressure-cooker environment of emergency medicine, providers are often operating without the staff, time, and information they need. Providing care to patients with high-acuity, urgent cases is rightly prioritized over obtaining demographic and coverage details, but this leads to a quagmire for billers.

Incorrect or incomplete information in the electronic health record (EHR) makes it nearly impossible to submit a clean claim. Denied claims kick start a frustrating and time-consuming cycle of billers hunting down additional patient, payer, and plan information. And if some information, such as active secondary insurance, simply isn’t found, providers are missing out on full revenue capture, further straining their resources.

This is, quite simply, unsustainable from the standpoint of operational efficiency. It’s critical for billers to be equipped with integrated revenue cycle management (RCM) optimization tools to help them submit clean claims and improve financial performance, so emergency medicine practitioners can continually improve their service levels.

Automated Tools That Reduce Workload and Increase Revenue Capture

Healthcare billing technology has come a long way. Market leaders have aggressively developed their solutions in recent years, adding significant depth and usability to tools that billers need to do their jobs effectively every day. For example, best-in-class billing, RCM, and practice management solutions can integrate tools such as those within the ZOLL® AR Boost® solution suite into their workflows. These RCM optimization tools work seamlessly with existing technology and can automatically find, correct, and verify patient and payer information:

  • Demographic Verifier can enhance core data for an average of 82% of patient encounters.
  • Insurance Discovery solves “coverage not found” errors and can identify active insurance, including retroactive Medicaid, for an average of 40% of patients presenting as self-pay.
  • Insurance Verifier confirms eligibility and benefits, and assesses coverage, co-pays, deductibles, secondary coverage, and codes.
  • Centralized Prior Authorization (PA) automatically validates PA requests, such as for admission or discharge to a post-acute facility, against payer guidelines to gain swift determination and adjudication from payers.
  • Deductible Monitoring tracks when the patient deductible has been met and shifts primary financial responsibility from the patient to payers.
  • Claim Status runs multiple, simultaneous claim status checks to provide insight into how a claim is progressing and ensures visibility through resolution and payment.
  • Self-pay Analyzer estimates a patient’s propensity to pay and determines eligibility for charitable or prompt-pay discounts and payment plans to improve self-pay collection rates by an average of 30%.

Just imagine what your RCM team could do with these tools.

Proven Benefits for Emergency Medicine Billers

If leadership needs convincing to make the investment, lean into proof. Billing teams who incorporated automated RCM optimization tools into their workflows have consistently been able to capture more revenue, reduce administrative burden, and improve the patient financial experience. More specifically, billers attribute these benefits to the ZOLL AR Boost solution suite:

  • Maximizes allowable reimbursement for emergency services
  • Improves the clean claim rate and speeds up time to cash by automatically enhancing patient demographics
  • Improves both self-pay collection rate and conversion to coverage
  • Boosts revenue by finding billable primary, secondary, and tertiary coverage in compliance with the No Surprises Act
  • Reduces front-end workload to accelerate revenue cycle and free up staff for higher-value activities

Ultimately, integrated RCM optimization tools work together to help emergency medicine billers receive timely, optimum reimbursement for services provided while driving down documentation headaches and manual RCM labor costs. Readers who would like to discover more evidence for the effectiveness of these tools are invited to download the white paper, “A Multi-pronged Approach to Closing RCM Data Gaps and Capturing More Revenue.”

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