Faster Claim Rates with Reduced Denials: Best Way to Improve Practice Revenue

Healthcare revenue cycle management (RCM) is fundamental to practice stability and profitability, yet it can be complex and time-consuming. A highly functional and streamlined RCM is a key part of administrative overhead and critical to the practice operations. Faster medical billing claim rates and minimized denials is the path to significantly boosting healthcare revenue. 

Understanding the Importance of Claim Processing

• Revenue Generation: Accurate and timely claim submissions are the lifeblood of a healthcare practice’s revenue.
• Patient Satisfaction: Delayed payments can lead to patient dissatisfaction and potential loss of business.
• Reimbursement and Collections: Delayed and inaccurate claims submissions will delay reimbursement from insurance payers and worse, increase denials. Delayed claims will complicate patient collection efforts and contribute to uncollected write-offs.
• Practice Efficiency: Streamlined claim processing can improve overall practice efficiency, lower human resource costs, and reduce administrative burdens.

Effective Strategies to Boost Claim Rates and Reduce Denials

Every practice must deploy these tactics below to ensure they are earning the maximum reimbursement for services delivered. Practices that are not operating using these RCM best practices are losing money and should consider outsourcing RCM to a qualified medical billing services company.

1. Enhance Patient Demographic and Insurance Information Accuracy
   • Verify Information: Double-check patient demographics and insurance details at every visit and phone engagement.
   • Update Records: Ensure records are up-to-date to avoid claim rejections due to incorrect information.
   • Use Electronic Health Records (EHRs): Leverage EHRs for automated data entry and verification.
2. Optimize Coding and Documentation
   • Comprehensive Documentation: Ensure that medical records accurately reflect the services provided.
   • Accurate Coding: Use the correct ICD-10 and CPT codes to accurately represent diagnoses and procedures.
   • Coding Guidelines: Adhere to coding guidelines and best practices.
   • Coder Education: Provide ongoing training to coding staff to keep them updated on coding rules and regulations.
3. Implement a Robust Pre-authorization Process
   • Identify Services: Determine which services require prior authorization from insurance carriers.
   • Timely Submissions: Submit pre-authorization requests well in advance of the service.
   • Follow-up: Monitor the status of pre-authorization requests and address any delays promptly.
4. Utilize Electronic Claim Submission (ECS):
   • Faster Processing: ECS can significantly reduce claim processing time.
   • Error Reduction: Electronic submission helps minimize data entry errors.
   • Compliance: Ensure compliance with payer requirements for electronic submissions.
5. Invest in Claim Scrubbing Software:
   • Error Detection: Claim scrubbing software can identify and correct errors before submission.
   • Efficiency: It can automate many claim processing tasks, saving time and resources.
6. Train Staff on Claim Denial Reasons:
   • Understand Denials: Educate staff on common reasons for claim denials.
   • Take Corrective Action: Equip staff with the knowledge to address denial issues effectively.
7. Follow Up on Denied Claims Promptly:
   • Appeal Process: Understand the appeal process for your payers and submit appeals within the specified timeframe.
   • Documentation: Provide additional supporting documentation as required for appeals.
8. Partner with a Medical Billing Service:
   • Expertise: Outsource billing to experts who can handle complex claims and negotiate with payers.
   • Efficiency: A medical billing service can improve claim processing efficiency and reduce administrative burdens.

By implementing the strategies outlined above, healthcare practices can significantly improve claim rates and reduce denials, leading to increased revenue and enhanced patient satisfaction.

However, navigating the complexities of revenue cycle management (RCM) can be challenging. Outsourcing medical billing processes to the experts at UnisLink is the solution to the both operational headaches and optimizing financial opportunities.

UnisLink is a Valuable Partner for Practice Success

UnisLink offers comprehensive RCM solutions tailored to the unique needs of healthcare practices. Our team of experts will:

• Conduct a thorough RCM assessment: Identify areas for improvement and develop customized strategies.
• Optimize medical coding and documentation: Ensure accurate and consistent coding practices.
• Streamline claim submission: Utilize advanced technology to accelerate claim processing.
• Negotiate with payers: Advocate for fair reimbursement rates and address denials effectively.
• Provide ongoing monitoring and analysis: Track key performance indicators to measure RCM effectiveness.
• Consult with Practice Executives for better performance: Work with RCM executives and managers to ensure the practice is fully optimized with operations and efficiency.

By partnering with UnisLink, healthcare practices can gain the expertise and resources needed to optimize their revenue cycle, maximize reimbursement, and ultimately achieve long-term financial success.

Contact us today and learn how we can help your practice maximize revenue potential immediately.