These days, people are struggling financially due to the economy’s current status, which has seen an increase in unemployment and the closure of several businesses in the aftermath of the worldwide coronavirus epidemic. Similarly vulnerable to pandemic-related downturns are health practices. Therefore, in light of the rising number of rejected claims, it is sensible to make an attempt to lower them in order to preserve your organization’s financial stability.
After all, according to the Medical Group Management Association, an estimated 69% of healthcare executives have seen an increase in rejections in 2021. At least half of the leaders who reported an increase in rejections stated it was up to 10% and 12% said it was as considerable as 30%. Any healthcare professional would be concerned by these figures, which would make them look for a remedy.
For practices of all sizes, from small single-family to big multi-specialty groups, tackling out-of-control rejected claims volume is advantageous. Utilize the crucial actions listed below to lower the rejection rate at medical institutions.
Confirm The Patient’s Information Upfront
Some healthcare facilities simply do not have the time to examine important patient information because they are overworked or overloaded with patients. However, this can be a prescription for financial ruin. You should underline the significance of lowering claim rejections. According to 42% of health care providers who spoke with the MGMA, the majority of rejections were due to previous authorization.
Train your staff to get this crucial data as quickly as you can, such as when making an appointment or during check-in time for a patient. By automating this procedure rather than having employees manually contact providers for each question to confirm each patient’s insurance status, you may save time. Regardless of how you do this work, you must continue to perform it regularly.
Let Patients Be Aware Of Their Responsibilities
Failure to adequately explain the specifics of what your patients are liable for might be one issue. A sign in the lobby is an excellent place to start. A standard document that patients must sign acknowledging that they have been advised of their financial obligations may also be included.
Posting this information on your websites and on other social media channels for your patients on a recurring basis are other strategies to distribute it.
Update Staff Onboarding And Training
Sometimes a lack of continuous (or enough) employee training causes cracks to form in an organization. Start by gathering your employees and reminding them that the diagnosis and treatments you give must be supported by the necessary clinical paperwork. Changes to the care must be noticed and supported, for example, by supplying the codes to enable longer patient stays or a specific treatment approach.
Make improving staff accuracy in medical coding a priority. They may need the training to stay current. Your recruiting, onboarding, and recruitment processes for employees should take into account all of these issues.
Send Out Claims As Soon As You Can
According to MGMA’s study, 7% of the healthcare professionals polled said that “timely filing” problems were the primary reason for refused claims. Any medical team can quickly and simply fix this. Send in a group of claims at once and on time. Determine the cause of some of the delays. Was it a mistake? Are your employees so busy that they are unable to meet the deadlines for filing and delivering claims? To improve the responsiveness of your company, identify the primary causes of delays.
Engage Consultants To Conduct An Audit
An organization may find it challenging to see itself objectively. You may not have the knowledge to recognize that your team’s claims and billing processes need to be improved. Although the office seems to be running well on the surface, there may be some issues due to a knowledge gap, for instance, in medical codes. You could only need the assistance of consultants doing a medical code audit to get things back on track with your team.
Enhance Your Computer Systems
Your computer system probably hasn’t received an update in a while. Medical offices prioritize minimizing risk; therefore, managers may be concerned about downtime while changing a computer network, installing the most recent operating system version, and installing essential applications. However, a more up-to-date computer system enables your personnel to perform more quickly and productively. Additionally, it offers you the most recent security safeguards and enables you to use specific claims denial management software.
Utilize Software Created For Managing Rejected Claims
Don’t attempt to get by with organizing and processing claims in a generic computer program before submitting them to insurers. Utilize a comprehensive software program to handle rejected claims. Your team’s refused claims will be shown, along with the justification for not paying. Then, you immediately resubmit the claim after using the program to make any required adjustments.
Lower The Number Of Rejected Claims As A Priority
Your organization’s income flow will significantly change if you focus on reducing the proportion of claims that are refused. If fewer claims are rejected, your budget may have more leeway, allowing you to hire more personnel or make equipment changes that will help the clinic and the patients you treat even more.
Bottomline
- It’s crucial for medical organizations to lower the number of refused claims at a time when many individuals are under financial strain.
- Healthcare executives predict an increase in refused claims in 2021 by at least 69%.
- Before you evaluate and treat patients, make sure your team checks their insurance status.
- Remind patients of their financial obligations to prevent miscommunication or late payments.
- As necessary, retrain employees and enhance staff onboarding to address mistakes that might result in insurance claim rejected.
- Employ specialized claims denial management software to increase productivity and enhance cash flow.
