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

If the world was perfect, at the finish of every revenue cycle management process (RCM) there would have been a 0% rate of claim denials and 100% rate of payment of the claims. This world is assuredly, imperfect, therefore, all of this is unachievable. There are however, many foolproof ways the RCM processes can be improved for smooth processing by identifying the issues that may present themselves preliminary to them occurring.

Looking at the occurrences of claim denials and rejections by the American Academy of Family Physicians (AAFP) report the average for the claim rejections can be said to be 5-10%. Claim denials and rejections can be proven to be the most complex and complicated of issues that arise in the healthcare system. Usually, claim denial and rejections or delays can be due to short and minor mistakes that are unnoticeable and unavoidable such as minute coding errors and billing errors. However, the main question could be- “How much loss does a healthcare organization face in revenues due to this?” Answer to this question can be provided in the Change Healthcare report that was published in 2017. It said that the true cost is $31.51 for the rejected claims.

There are many significant ways by which healthcare providers can prevent claim rejections, the first being:

Prevention

Prevention can be ensured by making sure no errors are made in the bills, and by carefully checking the codes for any mistakes. This helps prevent facing any claim rejection or delays as dealing with the problems beforehand rather than solving the problems later ensures reduced cost to collect later on.

Automation

Automation as known, claim management is still done manually by the average rate of 35%. Opting for automation would not only save time but also money making sure that the claims at the backend are cleaner and that the administrative costs at the front end are significantly decreased.

Integration

Integration is also a way by which we can reduce claim rejections. More synchronized the claims management and more streamlined they are-more is it guaranteed for a simple and an easy way to access the data for real-time analytics. This as a result, presumably prevents medical coding errors.

AltuMED understand and applies all this, our PracticeFit optimizes the whole claim management system with synchronized ease increasing revenues significantly. We ensure this by conducting thorough checks on the financial eligibility of the patients, running their insurance's analysis and monitoring discrepancies, the eligibility checker covers all at the initial stage of claim formation. If, however any error does creeps in the data submitted, our scrubber working on deep AI&ML algorithms is capable of scrubbing errors be it coding errors, incomplete or wrong patient financial information. The software, at present, has 3.5 million edits pre-loaded in its memory. To further streamline the process, automatic updates are issued by the clearing house to inform about the status of in-process claims.

AltuMed PracticeFit is a cloud based, easy to use, optimal claim management software that reduces denials rate to 2.1%. To find out more about its feature schedule a demo.