Improving payer reimbursement speed is a high priority for providers, and automation remains a key tool to accomplish that goal. According to the 2020 CAQH Index, payers and providers could realize up to $16.3B in savings through automation and by transitioning to fully electronic administrative transactions.
Many providers, however, either struggle to find a solution that’s right for them or are simply hesitant to make the change. That’s why it’s important to assess how much money unnecessary account touches could be costing you. Per that same CAQH report, for example, organizations could save up to $8.27 per transaction by switching from manual claim status inquiries to an automated approach.
Successful healthcare organizations understand the importance of submitting clean claims and use solutions that can automatically review and edit claims prior to submission. But over 5% of claims will still not be paid on that first pass, and payers can take anywhere from 14-60 days to resolve troublesome claims.
According to data from America’s Health Insurance Plans, the overall rate of auto-adjudication by payers is below 80%. That means many claims still require manual intervention during at least one point in their life cycle. The challenge with these then becomes quickly determining which claims need the attention of a system’s often limited staff.
Even the largest integrated delivery networks are challenged when attempting to hire enough professionals to scale the highly manual process into a comprehensive and timely claim status program. Hospitals process tens of thousands of claims per month, after all—that’s hundreds of claims per employee worklist and millions in missed revenue for the average-sized hospital. Here are two easy ways to leverage automation that can make a huge difference.
Two claim automation strategies that grow revenue
1. Use a solution with exception-based workflows
Exception-based workflows use automation to initiate and manage claim status inquiries without the need for staff input. Instead, work is only flagged for staff attention when it encounters an exception to routine operations.
This approach relies on intelligent tech that can automatically retrieve and normalize detailed claim status data from payer websites—a process much more efficient than staff making calls or hopping online themselves. With automation, approved pending claims are then removed from the queue, freeing staff to focus on more pressing priorities.
Automation also simplifies the process of correcting denied claims for resubmission while bolstering accuracy in important ways. Smart and proactive monitoring tools can scour payer websites for claims data beyond what’s available in standard EDI and return a detailed reason for denial, reducing additional research or payer follow-up.
To further streamline processes, claims marked for denial can be automatically routed to appropriate work lists. With tools to automatically flag priority tasks, staff are empowered to become specialized claim remediation experts who can prioritize tasks they have more experience handling.
2. Cut out outsourced claim status follow-up entirely
Experienced, professional medical billers ensure claims are accurately submitted in a timely manner and handle the heavy lift of chasing tough claims in need of remediation. But if staff are already equipped with tools to automatically identify and help manage those tough claims, outsourcing becomes unnecessary.
Automating claims monitoring turns a laborious process into a seamless remediation solution. Unlike with the generic response from an EDI, an automated solution can deliver clear action items with concise direction for your team. With the hard work of translating complicated payer responses done for them, staff know exactly what they need to do to remediate that claim.
In other words, by automating claim status workflows, you can follow-up and remediate a denied claim faster and without outsourcing, accelerating cash flow and capturing revenue that otherwise might be written off due to timely filing.
Accelerating automation adoption in the business office has the potential to transform claim status workflows far more quickly and cost effectively than any manual best practice. To accelerate cash flow, business offices must do more with less, making sure employees are supported by tools and tech that make their jobs easier. Automation just so happens to be the most effective way to do that.
Waystar’s Claim Monitoring solution automates and simplifies claim status checks, improving productivity while helping reduce AR days and write-offs. Click here to learn more.
Interested in the tech behind Claim Monitoring? Click here to learn more about Hubble, the AI and RPA platform that helps power many of our automated solutions.