Key Takeaways

  • 90% of claim denials are preventable.

  • Insurance payers create roadblocks with constantly changing guidelines and time limits that contribute to the denials landscape.

  • An RCM Platform that uses advanced automation, coupled with seamless integration, and domain expertise to collect aging amounts due would greatly improve reimbursement.

 

With the average insurance denial rate at greater than eight percent and missed or abandoned claims eroding net patient revenue by 3-5%, providers and their hospital partners should be keen on improving their systems to remain competitive in 2021 and beyond. According to recent Black Book Market Research, 80% of hospital leadership is vetting or considering vendors for RCM in the coming fiscal year.

The reason is simple; 90% of claim denials are preventable. Hospital and physician leadership are seeing the profound benefits of outsourcing their aged AR management process to preserve and maximize their healthcare payment life-cycle. By reducing the ongoing challenge of collecting on aged AR, they are more fully able to concentrate resources on better patient experiences leading to higher profitability across the board.

Current Challenges for Aged A/R Collections

Once an insurance claim has been denied, an intense manual effort must be initiated to determine follow-up procedures and collect the required information to resubmit during the claim lifecycle. Additionally, insurance payers have created roadblocks with changing, complex guidelines and time limits that contribute to the denials landscape.

Whether a practice or a hospital-based department, the technical reasons for denials are largely the same:

  • Missing insurance verification
  • Missed filing deadlines
  • Claim errors
  • Inaccurate coding
  • Missing documentation
  • Incomplete prior authorizations

What’s needed is a complete resolution that yields results quickly and is cost effective for the bottom line. A true AR solution would use advanced automation, coupled with seamless integration and domain expertise to collect aging amounts due while also improving billing processes, decreasing denials, and ensuring accurate coding for future reimbursement.

Solving Your Aged AR and Denial Problems

When considering an outsourced solution for improving your radiology billing and collections, look for an organization with proven results that uses forward-reaching technology and a hands-on approach. Recovery rates and aged AR liquidation percentages achieved by an outsourcing vendor are critical, but they must also be adept at providing in-depth education and training on front office functions (i.e., insurance verification, prior authorization), as well as provider documentation practices and regulatory compliance issues.

A vendor, with fresh eyes, can determine root causes through an in-depth analysis of the aged A/R and denied claims. They then can develop a multi-dimensional and robust resolution that identifies both a short-term collections fix and longer-term healthcare claim lifecycle solutions to prevent the future backlog from building up in the aged A/R.

A RCM Platform workflow would focus on reducing existing aged A/R and functioning as a seamless extension of the existing revenue cycle management function and would include:

  • Automated data analysis and recapture predictions
  • Denials prioritization
  • Consistent, fast recovery and liquidation
  • Frequent follow up by highly trained billing specialists
  • Ongoing analytics measurement and reporting
  • Ongoing analytics measurement and reporting to isolate root causes for problems

Expected Results for Aged A/R Billing and Collections

So what can be expected from engaging with a knowledgeable outsourcing partner? Swift and significant reduction in
> 90+ AR, substantial improvement in the turnover ratio, and better cash flow/bottom-line results. Not only does this contribute to keeping an organization financially sound, but using viable, up-to-date financial information will be helpful when negotiating future third-party contracts and reimbursement rates with the various insurance carriers.

Recognizing the maximum reimbursement for the services performed through faster liquidation, reduced aging, and higher recovery rates will pass benefits directly to the bottom line quickly and efficiently. Then you and your organization can focus on what lies ahead.

Request a demo for a complete RCM Platform journey and discuss the benefits Infinx could offer your organization.