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Achieving a Stronger Denial and Appeal Management Strategy

Achieving a Stronger Denial and Appeal Management Strategy

Waystar’s newest guide investigates the state of denials and appeals in today’s healthcare landscape and explores how today’s most successful providers are redefining the core components of their denial and appeal process to grow revenue, streamline workflows and revitalize their approach to the process.

Denial and appeal management today

Like many administrative tasks further burdened by the impacts of the COVID-19 pandemic, denial and appeal management workflows dependent on manual processes are experiencing new strains on accuracy and productivity.

Last year a survey investigated how billing and administrative tasks were impacted by COVID-19, with 37% of surveyed providers reporting an increase in workloads due to issues with coding and requirements. An assessment of the general industry outlook found claim denial rates are at an all-time high, with 33% of surveyed hospital execs reporting concerns they are entering a “denials danger zone,” where rates grow to 10% or more.

Estimates put the cost of reworking denials as high as 20% of rev cycle expenses because on average they cost 4x as much to process than the initial claim. With so much strain already present on providers’ resources, many are turning to automation to ease the burden.

How automation elevates the process

Once a provider has been notified of a denied claim, steps are taken to identify whether or not it can be appealed. Many of the errors that cause denials come down to administrative issues that took place at the start of the claim lifecycle.

A recent analysis found 86% of the denials processed between July 2019 and June 2020 were avoidable. Analysis indicated that many of those issues stemmed from front-end errors related to benefit information, coverage detail, and shortcoming related to missing or invalid claim data.

While there’s a wide mix of problems that could cause a denial, with different providers experiencing a diversity of challenges depending on their location and patient population, they all face a common hurdle: the burden of manual denial management and appeal procedures put on administrative staff.

Like many other administrative processes, providers for the most part rely on a mix of manual and electronic procedures to handle denial and appeal management. But the industry’s continued reliance on manual procedures is beginning to have a negative effect.

How providers are transforming their approach to denial + appeal management

Studies have found that it costs about $118 in reworking fees to appeal a denied claim. These costs are exacerbated by the industry’s overall reliance on manual processes—a systemic issue many recognize yet fail to capitalize on. Indeed, while many providers see the promise automation can deliver on, they still face a number of considerations before pushing forward with implementing an automated solution.

And automation is a hot topic for providers for a very good reason—studies have demonstrated the US healthcare system could save as much as $16.3B by automating old or outdated processes. When it comes to denial and appeal management, the benefits are far-reaching, from improvements to productivity and a reduced strain on resources to huge boosts to claim accuracy and revenue recovery.

What to look for in a denial + appeal management solution

Leading-class solutions offer a wide selection of tools to provide a comprehensive approach to denial and appeal management, using customized, exception-based workflows to streamline the entire process and overturn a sizable increase in denials.

The appeal toolset a solution offers should make it easier to coordinate and use the info and data necessary to automatically process appeals and recover cash that would otherwise create productivity issues or unnecessary fees.

The solution’s ability to prioritize appeals based on cash value automatically lets staff concentrate on tasks that actually demand their attention, supporting them with additional tools like automatically generated payer-specific appeal forms and robust analytics capabilities that allow you to track and measure progress and problem areas.

Keeping disruptions at a minimum is key when considering your solution as well, so consider its ability to work efficiently with your existing systems and look for a partner that can demonstrate a strong history of seamless integrations.

Wrapping it up: why denial + appeal management solutions matters

A recent Waystar survey found 76% of providers categorized denials as their biggest RCM challenge. And the wider picture of healthcare reflects an industry struggling to solve a long-standing problem with manual processes and few answers.

Implementing an automated denial and appeal management solution is quickly becoming the optimal path forward for most providers, even if many have apprehensions about committing to the switch. But as new innovations cut down on the resources and time needed to implement the tech, the time is quickly approaching where the switch will be easier, and more vital, than ever before.

Click here to find out how Waystar can help fully automate the process and help you recover more revenue while reducing the burden on staff.

Heading to AMBA in October?  Visit Waystar and EZClaim while you’re there!  Stay tuned for more event details.


ABOUT EZCLAIM:
As a medical billing expert, EZClaim can help the medical practice improve its revenues since it is a medical billing and scheduling software company. EZClaim provides a best-in-class product, with correspondingly exceptional service and support. Combined, EZClaim helps improve medical billing revenues. To learn more, visit EZClaim’s website, email them, or call them today at 877.650.0904.

[ Contribution from the marketing team at Waystar ]

4 Steps to Designing a Superior Patient Experience

4 Steps to Designing a Superior Patient Experience

Designing a Superior Patient Experience

We live in a world of increasingly lofty consumer expectations—one where 44% of U.S. consumers will switch to a competitor following a poor customer service experience.

The medical industry is no exception to this trend.

In a study by PatientPop, 58 percent of Gen Z, Millennials, and Gen Xers, as well as 63 percent of individuals 55 and older, said that responsiveness to follow-up questions via email or phone outside of the appointment is critical or very important to overall satisfaction.

Patients want more than just excellent care from their healthcare providers. They expect easy access to medical records, convenient online scheduling and appointment reminders, prompt responsiveness, and painless ways to contact your office—24/7/365. And they’re also seeking compassionate and knowledgeable representatives who are willing to provide caring and accurate resolutions to their issues.

As a medical provider, you should not only focus on bringing in new patients but also continually strive to improve patient retention. Growth in customer retention rates by 5 percent can increase profitability anywhere from 25 to 95 percent, after all.

So how do you design an experience that increases patient satisfaction and retention? Let’s dive in.

1: Make Prompt Call Answering & Convenient Appointment Scheduling A Priority

As we mention above, patients want—and nowadays expect—your office to answer quickly as well as provide effective and swift resolutions to their health matters. But in a busy office, the staff is often focused on dealing with patients. Even front desk and administrative teams can become inundated with in-office tasks at a busy practice, leaving calls, messages, and emails unanswered.

A superior patient experience starts with prompt call answering and convenient appointment scheduling—a service that’s available to your patients whenever they need you, including weekends and holidays, and answers every call addresses delicate patient concerns with empathy, and schedules appointments quickly. If your staff is struggling to keep up with demand, consider outsourcing your phone answering and appointment scheduling. Not only will this improve patient satisfaction, but it also brings a sense of work-life balance to internal staff and allows you and your team to focus on what you do best; caring for patients.

2: Streamline and Perfect Your Patient Intake Process

The patient intake process is tedious, but it’s incredibly important to your operations, and speed and accuracy are vital. Streamlining and perfecting patient intake starts with leveraging the right software—one that makes it easy for patients to fill in their information and access their records, and provides all of the valuable data your practice needs to operate in an easy-to-navigate platform. For starters, your intake software should:

  • Be encrypted for data transfer through the internet and HIPAA compliant
  • Be intuitive and user-friendly
  • Not require special software or hardware downloads or installation for the user
  • Be portable into back-end systems

Your intake process should also be integrated with your electronic health records (EHR) software, and information should be updated and available in real-time for a smooth experience—for patients, admin staff, and providers—so that everyone is up-to-speed. Both technology and your process should remove redundancies from your workflow and streamline the intake experience.

3: Provide HIPAA-Compliant Live Chat & Text For Swift and Convenient Communication

Another great way to improve patient experience is via live chat and text, through which you and your staff can communicate with patients wherever they are, send appointment reminders, have two-way private and secure conversations, multitask as needed and be available when emergencies happen.

HIPAA-compliant chat and text messaging lets you communicate efficiently and accurately with patients and simultaneously safeguards electronically protected health information (PHI) while taking full advantage of the speed and flexibility of today’s communication technology.

Some of the many benefits of secure live chat and text in the healthcare realm include:

  • Reduced response times, including in the off-hours and on weekends or holidays
  • Ability to provide immediate recommendations for care and preliminary diagnoses
  • Ability to send follow-ups, like reminding patients to take medications, which creates better relationships between you and your patients
  • Secure PHI storage that acts as a record of past conversations, symptoms, or complaints to improve future care, diagnosis, and treatment plans

4: Leverage Technology and Software Integrations For Smarter Decision-Making

Technology and software integrations have transformed healthcare and are vital in any medical practice. Why? Because when you streamline your office functions and workflows, you improve all aspects of patient care and experience.

First, your office should be using an EHR (electronic health record) system. This system automates access to client information, helping to improve workflows and reduce incidences of errors by improving the accuracy and clarity of medical records. It should include all the key clinical data relevant to each patient’s care, including:

  • Demographics
  • Progress notes
  • Problems
  • Medications
  • Vital signs
  • Past medical history
  • Immunizations
  • Laboratory data
  • Radiology reports

Communication data collected throughout your patients’ experience with your office—such as phone conversations, appointment scheduling, and reminders, and live chat and text transcripts—should also be sent to and recorded in your EHR system.

Finally, the right software can help you make better patient and business decisions. For instance, maybe you want to know the percentage of patient calls versus the percentage of calls from hospitals that come into your office. Or, maybe you want to know which hospitals call you the most or you want to know the main reasons patients call so you can use that information to improve patient care and education.

How The Highest-Performing Medical Practices Prioritize Patient Experience

Medical practices that provide a superior service experience are available to their patients 24/7, have a streamlined and accurate intake process, are tech-forward, and have omnichannel communication options that empower patients to reach out any time and from anywhere. But most medical practices don’t do it all on their own. The highest-performing medical providers leverage an outside service provider like Nexa to improve client satisfaction, increase retention and grow their revenue. Learn more about how Nexa can help your medical practice level up by visiting nexa.com/medical.


ABOUT EZCLAIM:
As a medical billing expert, EZClaim can help the medical practice improve its revenues since it is a medical billing and scheduling software company. EZClaim provides a best-in-class product, with correspondingly exceptional service and support. Combined, EZClaim helps improve medical billing revenues. To learn more, visit EZClaim’s website, email them, or call them today at 877.650.0904.

[ Contribution from the marketing team at Nexa ]

Medical Billing Technology Series

Medical Billing Technology Series

Medical billing technology is always changing, and usually much quicker than one expects. While your current processes may be working for you, there just may be something better available to reduce staff time and increase your revenues. The thing is, technology has made huge strides in the medical billing industry in recent years, offering a number of ways to send and receive data faster, while still protecting sensitive patient information.

So, over the next several posts, we will explore different features technology can offer to increase your efficiency as well as your bottom line. We will consider how your Electronic Medical Record (EMR) can communicate with your Practice Management (billing) software, the key features to look for in your Practice Management software, and how it can communicate with other programs, such as Clearinghouses and statement vendors.

 

This Medical Billing Technology Series will include:

    • Validation vs. Scrubbing
    • Rejection vs. Denial
    • Integrating With an EMR
    • Integrating With a Clearinghouse
    • Basics of ANSI/EDI Reports
    • Patient Collection Policy/Credit Card Processing
    • Using Templates
    • Is Integrated Eligibility Worth It?
    • Statement Options
    • Selecting a Practice Management System (Ease of Use/Access; Training; and Support)

 

Now, not every office will benefit from the same “bells and whistles,” and there are so many options out there. It can be overwhelming.  Chances are though, your office could benefit from considering some updates, and some may not even cost you at all!

EZClaim suggests that you take a fresh look at the workflows and processes that you have in place today, and start thinking about the tasks that are wasting time or that are causing delays in collecting payments (from both patients and insurance). These insights just may help you create a positive change to your workflow and your revenues!

 

So, if you need some help getting started, consider working with a consultant. One of EZClaim’s partners, RCM Insight, offers an annual fee schedule review, and during the month of February 2021, they will be offering four practices a FREE fee schedule review. So, visit their CONTACT US page for your chance to win! [ Note: RCM Insight uses EZClaim’s medical billing software for their billing services, so it could be a ‘win-win’ if you are—or will be—using EZClaim’s medical billing solution ].

 


ABOUT EZCLAIM:

EZClaim is a medical billing and scheduling software company that provides a best-in-class product, with correspondingly exceptional service and support. Combined, they help improve medical billing revenues. To learn more, visit EZClaim’s website, e-mail them, or call them today at 877.650.0904.

[ Contribution: Stephanie Cremeans with RCM Insight ]

4 Tips To Reducing Claim Denials in 2021

4 Tips To Reducing Claim Denials in 2021

Reducing claim denials has long been a challenge for providers. In the worst case, denied claims end up as unexpected—and sometimes unaffordable—bills for patients. The challenge only seems to be growingA recent survey conducted by the American Hospital Association (AHA) found that 89% of respondents had seen a noticeable increase in denials over the past three years, with 51% describing the increase as “significant.”

Minimizing loss will be top of mind for providers as the COVID-19 pandemic continues to put a strain on their resources, and minimizing or preventing denials will need to be a core part of that strategy. With that in mind, we’re offering four tips to help guide revenue cycle strategies for better denial reduction in 2021.

 

1. Analyze and Assess

In order to achieve and maintain a healthier denial rate, it’s vital to have a good handle on the factors creating problems in the first place. Keep the following in mind as you start to structure your analysis:

  • Review key performance indicators: Take a look at which metrics are being used to benchmark success or failure and see if it’s time for a refresh
  • Evaluate workflows: It’s important to have a clear understanding of how your team operates, and that you can detail workflows as step-by-step processes
  • Assess tools: Inventory the software you’re using and discuss with your team how it helps or hinders them
  • Staff efficiency: Consider the number of team members and resources involved in each step of the denial management process

It’s also important to talk to staff. Your team can offer invaluable insight on what is and isn’t working to help you develop a more comprehensive understanding of the shape and scope of the systemic issues contributing to your denial rate.

2. Reduce Errors Upfront

Eligibility, registration, and authorization errors remain the greatest cause of denials and write-offs, so a good first step is to focus on being proactive instead of reactive. Often, it’s easy to get into a routine where errors are only addressed after they occur. But incorporating tech to verify coverage and benefit accuracy in advance can lead to higher efficiency and much less manual labor spent to correct those issues later on.

Similarly, a recent AHA report found a failure to obtain prior authorization to be one of the most common reasons for a claim to be denied by a commercial health plan. In another recent survey, the American Medical Association found that 86% of providers surveyed were struggling with a high administrative burden created by prior authorizations.

Recent innovations have made the process simpler than ever. The right prior authorization solution can automate the process and make it simpler, smarter, and much less labor-intensive, reducing manual input errors and preventing denials.

3. Cut Down on Manual Labor

Claim denials are often the result of staff trying to keep track of a seemingly overwhelming number of rules and regulations while juggling various systems and filing requirements. When your staff is overburdened, it’s that much easier for them to make simple errors or miss deadlines.

There are numerous tools available for teams who are either struggling with paper-based processes or databases without automation. With an AI-powered solution, you can streamline a number of time-consuming tasks while simultaneously automatically ensuring you’re identifying missing data or claim errors that can be corrected before they’re submitted.

It’s also a good idea to review any potential new tools with your team. Their insight will help you properly determine which solutions will actually improve their workflows, and which could prove an expensive time sink.

4. Use Stronger Reporting Tools

Accurate and in-depth reporting should be core to your strategy. Effective reporting tools let you quantify and assess the issues that influence your denial rate, allowing you to easily spot persistent workflow errors or other systemic problems that can create extra work or strain resources.

New tools powered by AI and machine learning offer more robust reporting options than ever, with advanced analytics and visualization capabilities that make it easy to explore complex data sets or identify trends. Mountains of information can now be easily managed and measured, giving you access to operational insights that will help you better understand problem areas and identify opportunities for improvement.

 

The Wrap-up

With the right tools, a solid strategy, and expert guidance, you can take a proactive approach to reducing claim denials. Our automated tools make it easy for your team to streamline their workflows while reducing errors and administrative costs. With Hubble, our AI and RPA platform, you can unlock the insights you need to reduce your denial rate and increase cash flow.

Waystar, a partner of EZClaim, also offers a number of front-end solutions to help you take a more proactive approach to your denial rate.  Click here to learn more about how Waystar can help you with reducing claim denials and claim management. For more information about Waystar’s platform, visit their website, or give them a call at 844.492.9782.

To find out more about EZClaim’s medical billing software, visit their website, e-mail their support team, or call them at 877.650-0904.

[ Contribution: Waystar ]

Get the Most Out of Your Analytics

Get the Most Out of Your Analytics

Today’s healthcare landscape faces truly unprecedented challenges, which means it’s more important to get the most out of your analytics to develop more informed, strategic decisions. There’s a deep well of data that each revenue cycle feeds into, which if properly analyzed, can help organizations operate at their most efficient and effective. Here are the four stages of data analytics workflows that are key to developing those actionable insights: A “Trigger,” or the point in your revenue cycle that sets up the call for deeper analysis; “Interpretation” of data to determine root causes and identify appropriate next steps; “Intervention” to improve specific metrics; and “Tracking” of said metrics to chart success in achieving desired outcomes.

 

So, let’s examine what a successful version of each stage looks like:

Trigger:
The trigger occurs when you notice something that needs further investigation. With the right analytics tool you can easily access all of your key performance indicators, financial goals and more, providing the visibility you need into your rev cycle. When something looks amiss or needs improving, you can drill down to the level that shows what’s really going on.

Interpretation:
Even a wealth of data amounts to nothing without an efficient way to process and communicate key takeaways. You’ll need to equip your team with access to concise reports, smart visualizations and relevant historical data in order to get them to the insights that drive action.

Intervention:
Now is the time to take action. Intervention is ultimately tied directly to your ability to drill down into the data underlying problematic areas of your revenue cycle and clearly communicate takeaways with your team. Success at this stage depends on designing a plan based on your best understanding of underlying issues and the most effective way to address them.

Tracking:
Your intervention plan is built on KPIs that naturally intertwine with the way you measure success across your revenue cycle. With proper implementation and tracking, running with the analytics cycle can become a simple addition to your everyday workflow. More than delivering on your initial goals, the true power of analytics is the ability to deliver repeat value on your initial investment.

 

Wrap Up
A strong analytics solution does more than deliver a more fully developed picture of your revenue cycle performance. It provides actionable business intelligence, cuts down on time between analysis and action, and lessens the strain on your IT department.

 

Waystar is a ‘partner’ of EZClaim, and provides analytics for a practice using their medical billing software. For more details about EZClaim’s products and services, visit their website: https://ezclaim.com/

To learn more about how Waystar can help you harness the power of your data, call their main office at 844-4WAYSTAR, or call sales at 844-6WAYSTAR.

[ Contributed by Waystar ]