Grit your teeth and make the handoff. Offer up the responsibility that goes with the work and build in both accountability and meaningful rewards.

All too often we expect that things are getting done and it’s not until it’s too late that we find out differently. The problem is twofold. Many providers, practice owners and managers don’t delegate effectively. You can’t expect someone to do a job if you haven’t outlined what you want them to do.

Do you know? According to a new study published in the January 2022 issue of health affairs : Medicare and Medicare Advantage policies result in more than 5.6 million claims denied between 2014 and 2019. A 2017 analysis conducted by Change Healthcare revealed compelling statistics about claim denials and their financial impact on medical practices. The finding showed that out of $3 trillion medical claims submitted by hospitals and medical practices in the United States in 2016, $262 billion of those charges were initially denied. Even though 63% of those claims were recoverable, it still came with a cost of $118 per claim, or as much as $8.6 billion in appeals-related administrative costs.

 

30% of claims are either denied, lost or ignored. (Source: Center for Medicare and Medicaid Services)Medical claim rejection and denials can be the most significant challenge for a physician’s practice. Even the smallest medical billing and coding errors could be the reason for claim denials or payment delays. As a result, they can have a negative impact on your revenue and your billing department’s efficiency. In addition, frequent errors can negatively impact the relationship you have with patients.

 

Out of all the denied claims, 65% of them are never reworked. That’s huge! When this happens, your practice is losing money. It is possible to drastically decrease your denials and efficiently manage the denials that do occur if you simply make sure that no important information is missing on the claim. (source: Change Healthcare)

 

Hospitals write off 90% more claim denials costing up to $3.5 million. In 2017, health systems and hospitals wrote off 90% more claim denials as uncollectible compared to six years ago. This information was gathered from healthcare executives at 90 organizations and data from nearly 300 organizations. For a hospital with a median of 350 beds, the increase in uncollectible claim denials would signify a $3.5 million loss over the past year. Although hospitals and other health organizations can recover their losses by appealing their claim denials, however recent trends suggest that appealing a successful denial has become more complicated for hospitals and healthcare organizations. (Source: Advisory Board)

 

A study from the Harvard Medical Practice found that 70% of errors, resulting in adverse events, were considered to be secondary to negligence, and more than 90% were judged to be preventable. It is important to note that one error can result in claims being denied or rejected. When this happens, your medical practice will likely lose money because you will not be fully paid on the services you provided.

All these can never happen if you eye on your billing process.

 

How we come into the picture :  As an expert, having decades of an end to end RCM experience, we will review and analyze your billing company data or your in house billing data and will let you know where you are lacking and losing your hard earned money.

 

We will pull the different types of reports from your billing system such as an Account Receivable Aging Report: This report serves as a gauge for the health of a practice/provider/hospital/facility and indicates if the billing department is doing its job properly.

We as an expert review, research and let you know, what information will this report provide.

Payment Trend and Collection reports

The Key Performance Indicator report

The Top Insurance/Carrier Analysis report

Patient Payments

Clearing–House Rejection Report

Tracking Payer Reimbursement metrics

Tracking Denials

What CPTs are contributing to the maximum revenue of your practice

What CPTs are not or less contributing to the revenue of your practice

Number of claim submitted vs Number of claims paid

 

Conclusion:  We research and analyze these reports and diagnose your financial health and we empower medical practices and facilities to provide you with a detailed report on where your practice is lacking in potential reimbursements, increase reimbursement average and remain financially sound.