According to a recent Healthcare Information and Management Systems Society (HIMSS) survey, 76.1% of healthcare leaders say denials are their greatest challenge within RCM if you want to reduce rate of denials. Denied, rejected, resubmitted and underpaid claims can cost your practice as much as $100,000 per month according to the AMA. This is precisely why outsourcing of Revenue Cycle Management continues to rise and the market size of the industry is projected to reach USD 286.7 billion by 2028. However, partnering with a Revenue Cycle Management (RCM) company can help you reduce the rate of insurance claims denials and improve your bottom line and reduce rate of denials.
10 effective ways an RCM company can help your practice reduce rate of denials
- Advance Verification of Patient Eligibility
RCM companies can verify patient eligibility before the patient’s appointment. Infact, It’s one of the first steps in the revenue cycle management (RCM) process and can set the stage for the overall patient-provider encounter. RCM companies are trained to verify patient eligibility with the help of online tools such as insurance company websites, directories, and payer portals which provide eligibility and estimate information. This ensures that patients have active insurance coverage, thus reducing the likelihood of reduce rate of denials due to eligibility issues while also engendering timely reimbursements.
- Accurate Coding and Billing
Reputed RCM companies employ certified coders and billers who are up to date with the latest coding rules and regulations. This expertise ensures that claims are submitted with accurate codes, reducing the chances of denials due to coding errors. A survey conducted by the Medical Group Management Association (MGMA) showed that medical practices utilizing medical billing companies typically see improved performance across their Revenue Cycle. Infact, 59 percent practices decreased the volume of lost/denied claims to reduce rate of denials..
- Identification of Coding Errors
In addition to accurate coding, RCM companies are trained to review your claims for coding errors such as unbundling, upcoding or undercoding, improper reporting of time- based codes such as infusion and hydration codes etc. Such errors will be addressed promptly, ensuring that claims are paid correctly and on time. This is possible because outsourcing partner engage highly skilled teams of coders and have well-defined processes and metrics, to minimize errors and ensure that bill payments and reimbursements are received in a shorter period of time to reduce rate of denials.
- Appeals Management
RCM companies are expertly equipped to handle insurance claim denials and appeals. From getting to the root cause of denial and a deep understanding of the appeal process they can navigate effectively to ensure that your claims are paid.
- Administration of Denied Claims
RCM companies can review denied claims to determine the reason for the denial and address it promptly. They can also track unpaid claims and follow up with insurance companies to ensure that they are paid. With their expertise, RCM companies are quick to see that each denial presents an opportunity for reduce rate of denials. While appealing a reputed RCM company is sure to follow deadlines, respond promptly to any requests for additional documents and ensure precise documentation such as including copies of demand or decision letters at each level. Since it is an RCM company’s priority to ensure reimbursement for your practice, they also have the necessary bandwidth to consider each claim meticulously.
- Ongoing Training and Education:
RCM companies provide ongoing training and education to their staff, ensuring that they are up to date with the latest regulations and rules. This expertise helps your practice stay compliant and reduces the likelihood of claim denials due to non-compliance.
- Timely Submission of Claims
Each payer defines its own time frame during which a claim must be submitted to be considered for payment. Filing deadlines often range from 90 days to one year from the date of service but may be as short as 15 to 30 days. RCM companies ensure that claims are submitted in a timely manner and in the correct format. This helps reduce the likelihood of denials due to missed filing deadlines.
- Continuous Monitoring of Claims
RCM companies continuously monitor the status of claims, ensuring that they are processed and paid on time. They also identify any trends in claim denials and address them proactively.
- Patient Communication
RCM companies can help with patient communication by providing clear and concise billing statements and addressing any patient concerns or questions promptly. This helps reduce the likelihood of claim denials due to patient confusion or disputes. By bridging the communication gap, RCM firms and healthcare providers can help patients get access to vital safety, clinical and payment information which in turn leads to fewer denials and more timely reimbursement to reduce rate of denials.
- Increased Revenue
By partnering with an RCM company, your practice can increase revenue by reducing claim denials and improving the efficiency of your billing processes. This increased revenue can be reinvested in your practice, helping it grow and thrive.
Partnering with an RCM company can help your medical practice reduce the rate of insurance claims denials, improve your bottom line, and ensure that your practice stays compliant with the latest regulations and rules. At EMPClaims, we have a proven track record of helping medical practices reduce their claim and reduce rate of denials and increase their revenue. Contact us today to learn how we can help your practice.