Over the past few weeks, we have been looking at some common challenges in revenue cycle management (RCM). Today, we’ll tackle the need to closely monitor claims throughout their entire lifecycle.

Monitoring from the start of the claim to the final payout is imperative in order to detect errors and possible denials or rejections that will result in lost revenue.

There are four main stages of the lifecycle of an insurance claim; submission, processing, adjudication, and payment/denial. Having skilled personnel and a well-monitored process to oversee each step along the way can help decrease mistakes as well as ensures payment in a timely manner.

Claims go through many people, from the front desk staff and the provider to billers and coders. Everyone must be in direct communication and be well organized to complete each specific task. RCM is dependent on the linkage of people and the process.

Errors in claims can create a delay of reimbursement and may result in some claims being swept under the rug if not followed through. At a 20% error rate in claim submissions, submitting a clean claim on the first go is crucial. Taking the time to verify a patient’s benefits prior to a procedure or double-checking the accuracy on claims is well worth it. If a mistake is made, resubmitting the claim in a timely manner is also important to allow less in time in A/R. 

It’s imperative to have an appeal process to ensure you are receiving the reimbursement you deserve, but also to avoid making the same errors which, in return, can boost revenue by submitting accurate claims the first time around. Investigating denied or rejected claims can be very time-consuming but needs to be prioritized in order to receive full reimbursement. Tracking information helps you to see what’s working and what may need to be adjusted in the future.

Insurance companies make mistakes too. Take the time to read over the EOBs for accuracy. Verify that your information is correctly billed and then make sure the payment matches the procedure.

Health information technology (HIT) has made submitting claims faster and simpler. Electronic transactions make it easier to ensure payments are correct by allowing you to spot problematic claims before they are submitted. Electronic claim scrubbing lets you correct errors in minutes instead of weeks. However, HIT still requires manual input and therefore should be crosschecked. 

Reimbursement is not the only vital part in revenue cycle management. Avoiding errors by accounting for all physicians is crucial. Claims can be denied due to improper credentialing making it important to stay on top of the accuracy and the timely re-credentialing process.

Healthcare organizations that are successful in managing RCM have access to the big picture. They have a dedicated staff and a streamlined process to stay organized and get the job done.

At Reliance Medical Billing Solutions, we are ready to partner with your team. From pre-authorizations, claim submissions, appeals, monitoring, and credentialing, we are here to assist where needed. Contact us at 717-740-2622 or visit our website at www.reliancembs.com to learn more and to receive a customized quote of our services.