Dec 11, 2019 | Partner, Revenue, Trizetto Partner Solutions
Need Help With Your To-Do List?
Need help getting your To-Do list done? We have you covered!
With 2019 nearing its close, now is a great time to evaluate your revenue cycle management
and look for areas of improvement in the coming new year. Make 2020 the year you put the
focus back on your patients by automating your revenue cycle and improving your bottom line.
The best place to start is by ensuring you get your To-Do list done early!
Making the list is just like a New Year’s resolution: Easy to do but hard to complete without a
partner there to support you. The right solutions should be at the root of your strategy. EZClaim
and TriZetto Provider Solutions (TPS), a Cognizant Company, have the tools and support to
make a difference in your practice and can help you get through the list:
- Go digital – Check!
- Improve denials management – Check!
- Get paid faster – Check!
If these challenges are at the top of your 2020 To-Do list, get in touch with our revenue
cycle experts now to find out how we can help you check them off your list and make sure you
are ready to recoup all that you are owed in the coming new year.
In the meantime, download our infographic with the details of the financial and operational
benefits of getting your To-Do list done early this year.
Dec 10, 2019 | Alpha II, Claims, Partner, Revenue
Getting Claims Right the First Time
Getting Claims Right the First Time. Contributed by Timothy Mills, Chief Growth Officer, Alpha II, LLC
The numbers are staggering. Industry averages report that nearly 20% of all claims are denied, rejected, or underpaid. And considering the cost to rework claims — not to mention even higher appeal costs — as many as 60% of returned claims are never resubmitted.
With figures like these, it’s no wonder medical practices continue to face intense financial pressure. As negotiated reimbursements stagnate and operating expenses like rent and salaries continue to increase, the struggle to maintain steady revenue becomes even more crucial. For many practices, conducting reviews of their revenue cycle workflow would show gaps in their claims process. The good news is – these gaps can be bridged with the help of emerging technology.
With a saturated market of coding, billing, and compliance solutions, how do you begin to find the right technology for your practice? When trying to improve revenue integrity, it is important to understand exactly what vendors offer. For example, consider the term “first-pass claims rate,” which is still used by some healthcare IT vendors to represent the number of claims initially accepted by payers. But what is often overlooked is the number of those initially accepted claims that will be denied or underpaid. A better question would be – what percentage of claims are getting paid the first time they are submitted?
The fact is, practices that do not employ the latest clinical coding and editing tools within their revenue cycle are leaving money on the table. This is revenue that is rightfully theirs but is being pursued at high, incremental costs. It’s time to rethink traditional denials management practices, move beyond the “first pass claims rate,” and embrace the future of denial prevention.
It’s your money. Go after it.
Still not convinced that investing in emerging clinical coding and editing software can save your practice money? Let’s see what relying on traditional denials management methods might really be costing you.
Each rejected, denied or underpaid claim represents earned revenue your practice is missing out on. Based on industry reports, the average cost to rework a claim has been pegged at more than $25, and appeal costs can skyrocket to over $100. It’s estimated that as many as two-thirds of all denied claims are recoverable. But practices often weigh the reimbursement amount of a claim against the cost to rework or appeal that claim. For smaller claims, many decide it just isn’t worth the effort, which is why getting claims right the first time should be the ultimate goal.
So how much are practices losing by simply correcting and resubmitting denied claims using traditional denial management methods? Let’s look at an example using figures from an actual mid-sized specialty practice. This practice submits 1,900 claims a month and the average claim is $150. They have a better-than-average denial/rejection rate of 10 percent. Even with that lowered rate, this practice is losing roughly $28,500 a month to unresolved denied claims. If two-thirds of those denied claims are recoverable, they stand to recoup $19,095 in reimbursements after the claims are corrected and resubmitted. Factor in the cost associated with reworking denied claims using the industry average of $25 per claim, and this practice is spending $4,750 in administrative charges alone to recover their own revenue. This brings their actual recovered revenue down to $14,155 per month or almost $170,000 annually. Investing in a comprehensive clinical coding and editing solution is still cheaper than what the practice spends per month when reworking denied claims.
The Alpha II Solution
Are you ready to submit precise claims the first time? Contact Alpha II, a leader in revenue cycle solutions. Our comprehensive clinical claim editing solution, ClaimStaker, covers the entire continuum of care, verifying claim data from the payer’s perspective and allowing for corrections prior to filing.
Check out our Denial Impact Assessment Calculator to see what your denials really cost your practice or contact us today for a free personalized Claims Assessment. See why ClaimStaker does more than clear claims. It gets claims paid.
We work hard to update our blog to keep you up-to-date on what’s happening in the field of medical billing software. If you have a topic you would like to see discussed, please contact us.
Dec 10, 2019 | BillFlash, NexTrust, Partner, Revenue
9 Signs It’s Time to Outsource Your Medical Billing and Coding.
Contributed by James Easley, VP, Marketing of NexTrust, Inc
Should a practice outsource their billing and coding or manage it in-house? This is one of the most important business decisions for practices to get right. Which is the better option for your practice? Here are nine signs that it may be more financially beneficial to outsource medical billing.
1. Do You Lack Visibility into Billing and Payment Metrics?
Do you know your key financial metrics and how to improve them? Many practices are not aware of their actual revenue metrics which are the “vitals” for the financial health of their practice. For example, only about 35% of practices appeal denied claims, which means most are losing out on thousands of dollars every month.
Without the ability to measure these financial vitals, it’s difficult to know how to improve. Does your practice have a financial analyst as well as the staff with the skills to identify problems and make improvements? If not, practices should consider looking at external experts to provide these metrics and are able to make the necessary billing improvements.
2. Is Your Revenue Decreasing?
For practices that are aware of their billing and payment metrics, are you seeing your collections decrease? Is the time it takes to collect increasing? Unfortunately, this is more and more common among practices due to the ever-changing complexity of the insurance billing processes. Outsourcing is not the only solution, however fixing this problem internally can often be costlier and time-consuming than outsourcing.
You need a solid income stream to keep your clinic operating effectively. If billing mistakes, coding complexities, and reduced reimbursements or denials have negatively affected your collections, then you need to consider outsourcing your billings and collections to keep your company from falling victim to a bad revenue stream.
Not only does this keep your business running optimally, but it also allows your personnel to focus on other responsibilities and ensure quality customer service.
3. Are Billing Errors and Rejected Claims Costing You Money?
The American Academy of Family Physicians reports that a 5-10% denial rate is the industry average. To be financially sound, practices should do what’s necessary to keep this rate below 5%. Because high claim denial rates require additional costs and staff time to correct and resubmit, many practices have found the outsourcing resolves this issue and provides higher net income overall.
4. Are You at Risk of Staff Absence or Turnover?
While every industry faces the challenges of staff turnover, the effects are often felt acutely among medical practices when billers leave. Since claim processing is integral to the lifeblood of a practice, replacements or new additions to your billing department unavoidably result in a slowdown in claims processing. Practices can remove this variability and risk through outsourcing their billing and pushing the staffing burden to the third-party. Practices then rely on a team that can ensure the work of claim processing continues without interruption.
5. Are Staff Billing and Coding Skills and Training Insufficient?
Many practices take on the responsibility of hiring, managing and training Internal billing and coding staff. This works well in many practices. However, if billing and coding staff is under-experienced or not current on compliance and regulatory issues, practices must cost-effectively provide regular training to get and keep them current. Practices that prefer not to take on these burdens can find a simple solution in outsourcing.
6. Has In-house Billing Become Too Expensive?
Considering the costs of hiring, salary, benefits and administrative costs of in-house medical billers, practices may find it costs less overall to outsource their billing.
In addition to employee costs, practices must purchase equipment, software, and more. In-house billing costs can quickly add up. Practices should compare internal costs to outsourcing to determine both the best operational and cost-effective methods for billing and coding management.
7. Do You Have New Providers or a New Practice?
Newer practices may find it difficult to navigate the complexities of medical billing and coding. These new practices or practices with new providers need to ensure they are focused on growing their business and providing a high level of care.
Delegating important responsibilities to a trusted third-party allows new practices and providers to do just that. Outsourcing your medical billing during this time can relieve the burdens of hiring, training or managing a team of new billing employees.
8. Is Your Clinic Growing?
A growing practice can have similar challenges as a new clinic. Reputation is critical when growing your business and ensuring high-quality patient attention and care can become more difficult.
As your staff will likely be tasked with more responsibilities and duties during this growth period, why not ensure they can still provide meaningful services by taking some of those administrative duties off their hands. Your personnel will thank you for this by continuing to provide quality care to patients, which in turn will help you to continue growing.
9. Is Your Attention Divided Between Patients and Running a Business?
Overseeing internal billing and coding requires a substantial amount of effort, time, and expertise. Without dedicated staff to handle this, the responsibility can fall on the shoulders of clinic owners, physicians, or other administrative staff.
This can mean less time focusing on patients or other relationships and practice management responsibilities. When practices outsource the billing process, physicians and administrators are free to focus on providing quality healthcare services to patients.
If you found yourself nodding your head to one or more of these questions, it’s worth taking some time to learn if outsourcing would be better for your practice. NexTrust offers both patient and insurance billing services that not only improve revenue but allow providers and staff to focus on providing the highest level of care.
Free $25 gift card with RCM demo
Call NexTrust today 435-940-9123 or email us at rcm@billflash.com to learn how our Patient Billing and Insurance Billing services can improve the financial health of your practice.
Stay tuned to our blog for the latest information related to the medical billing field from EZClaim and our esteemed partners.
