Preventing Claim Rejections: Three Ways to Increase Revenue for Medical Practices and Healthcare Systems

In a perfect world, there would be no claim denials, and all claims would be paid. But our world isn't perfect, so this isn't possible. However, there are many ways to improve the revenue cycle management (RCM) process to reduce claim issues by identifying problems before they happen.

According to the American Academy of Family Physicians (AAFP), the average claim rejection rate is 5-10%. Claim denials and rejections can be some of the most complicated issues in healthcare. Usually, these problems are caused by small mistakes like coding or billing errors. But how much do these mistakes cost healthcare organizations? A 2017 report by Change Healthcare says the cost is $31.51 for each rejected claim.

Here are some ways healthcare providers can prevent claim rejections:

Prevention

Prevent errors by making sure bills are correct and checking codes for mistakes. This helps avoid claim rejections and delays, reducing costs later on.

Automation

Many claim management tasks are still done manually, about 35% on average. Using automation saves time and money by making sure claims are cleaner and reducing administrative costs.

Integration

Integration can reduce claim rejections. When claims management is more synchronized and streamlined, it's easier to access data for real-time analysis. This helps prevent coding errors.

How AltuMED Can Help

AltuMED understands these methods. Our PracticeFit software optimizes the claim management system, increasing revenue. We do this by:

• Checking patients' financial eligibility
• Analyzing their insurance and monitoring discrepancies
• Using an eligibility checker at the start of the claim process

If any errors are found in the data, our scrubber, powered by AI and ML algorithms, can fix coding errors and incorrect patient financial information. The software has 3.5 million edits pre-loaded. To make the process even smoother, the clearinghouse issues automatic updates on the status of in-process claims.

AltuMED PracticeFit is a cloud-based, easy-to-use, optimal claim management software that reduces denial rates to 2.1%. To learn more about its features, schedule a demo.