Even if your current claims process brings in a steady stream of reimbursements, it might surprise you to learn that hidden fees and inefficient protocol unnecessarily cost you thousands of dollars each month. It is impossible to push every medical claim through without a few slipping into the dreaded “pending status,” but there are steps your practice can take to avoid processing delays and costs associated with denials and appeals.
Medical claims processing grows increasingly more complex, more stringently regulated, and more labor intensive every day. Streamlining the billing process is essential to controlling costs and providing high-quality care simultaneously.
Industry research shows $850 billion is wasted every year in the United States on needless errors and inefficiency. A 2011 review of millions of electronic medical claims revealed that 23% of claims submitted by physicians and clinicians were denied based on “unsatisfied patient” deductible requirements.
To assist physicians seeking to lower overall denial rates, the AMA offers tips on initiating point-of-care procedures designed to help your practice achieve “better performance” and collection outcomes. While point-of-care procedures help physicians capture more patient payments at the time of service, highly efficient practices continue billing about 10% of patient visits, according to the AMA.
Electronic Health Records (EHR) Efficiency Benefits
Shifting your practice from paper-claims filing to cloud-based processes allows administrative staff to actively control record-keeping costs, streamline billing and reduce medical errors.
In the January 2014 Retrospective Review, CMS reported that medical professionals can expect to capture substantial savings by participating in Medicare and Medicaid EHR incentive Programs.
Equipping your administrative staff with tools they need to reduce errors and manage your revenue cycle improves efficiency and accuracy; saving time and money for small, medium and multidisciplinary practice models. For the greatest benefit from your EHR system, replace manual claims review with automated coding tools that virtually eliminate up to 98% of coding errors before your staff submits electronic claims to payers.
Change Your Office Routine for Stronger Reimbursement Control
One more point about changing from manual claims processing to electronic processing with coding tools – the Medical Group Management Association (MGMA) explains that an “unclean submission” rate of just 10% can cost your practice more than $2500 a month. And while evidence shows that electronic filing reduces cost by catching coding and modifier errors; electronic filing is also less expensive than paper claims filing. Filing a clean claim electronically saves almost $3.75 as compared to a paper-claim filed by standard mail.
Another consideration for physician practices is the in-house filing schedule. Many clinician offices file claims in batches, one day per week or on a bi-weekly basis. Delayed processing, delays reimbursement – which hampers timely cash receipts for your practice.
Finally, surveys reveal that electronic medical claims settlement is more than twice as fast as paper-based claims.
MGMA recommends a monthly review of first-pass ratios and clean claim ratios to control hidden fees and avoidable costs. Here’s what you need to know and steps you can take today to cut your medical claims costs:
- A clean claim is one that is properly coded; each field properly populated and otherwise not requiring additional review or information once submitted to the payer.
- A first pass ratio is the percentage of claims that make it through the clearing house without modification or returns for review.
- Inform administrative staff how ratios and errors impact the practice financially.
- Consider system upgrades that allow you to create reports to monitor errors, confirm eligibility and perform coding audits.
- Explore reasons for denials; if your practice receives a high volume of denials for “services not covered” each month, you billing staff might be using incorrect codes.