You have to protect the revenue you’re bringing in the door right now, and make sure that what you do protects that revenue down the road.
Insurance companies return claims an average of two times to get the information they require to process the claim. They know that if they continue to deny, they usually win. While providers may never completely beat them at their game, they should do their best to stay in step.
Read through these missing pieces given by Becky Black, former vice president of revenue cycle at Southern Regional Medical Center, and make sure you have the proper procedures and tools in place to protect your bottom line.
1. Denials “falling through the cracks”
A lot of low level claims add up quickly. One hospital that assigned an FTE to working low-level denials ended up recovering $750,000 by using proof available through the Trace system.
2. Reliance on “homegrown” databases and manual spreadsheets to track performance
So many hospitals still can’t get good data using databases they’ve created. Be sure to ask for the tools you need to do your job properly – it can save you thousands.
3. Not prioritizing denied accounts for resolution
Being able to chronicle why you have the right to be paid in the first place, and making sure you’re saving those communication issues within Trace, will save you a year, two years down the road when you have that support system at the click of a button. That’s the beauty of working with Trace.
4. Inconsistent follow-up activity on accounts
Are you recording or capturing the website that says no pre-cert required on the date you viewed it? It is extremely powerful to have web visit chronicled or have a recorded phone call that says “no precert required.” That, along with proof that you supplied all of the information requested, is guaranteed to help get that claim overturned when the payer denies for lack of precert.
5. Lack of understanding of root causes of denials
You have a ton of information out there. Trace helps you manage it all with ease, saving you researching time and effort, which quickly translates to dollars.
6. Inability to speed account resolution with payers
Communication is critical to solving denials and harnessing information to drive revenue cycle performance. Capture it all in Trace, and proof is just a click away.
7. Poor communication among departments and revenue cycle functions
It’s so important that all players from the front, middle and back of the revenue cycle be pulled together to communicate effectively, eliminating silos and breakdowns in communication. When you don’t have a system in place to make sure paperwork is flowing correctly, not only are you not getting paid, but the hospital is also paying for the cost of the services. That’s a big hit to your bottom line.
Just think about one overturn, one case that doesn’t get denied or doesn’t get stopped. Think about saving one canceled procedure, saving one patient from frustration or keeping one doctor happy.
There are a lot of ways to look at how the systems we’re using in our hospitals bring value. Allow the people who do their jobs every day to be involved in how they can help you fix the problems. Let them help you put Trace to more use, and potentially save your hospital even more money and frustration.
“I believe so much in what Trace is capable of doing. We just have to be more creative in how we put it to use so that we can continue coming out as winners” – Becky Black