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There are many reasons for the failure of a healthcare facility and claims denial is a major concern for the facilities as it results in missing out on huge revenues that are due. Thus, it becomes vital for healthcare facilities to monitor the claims on a daily basis as a part of revenue cycle management. Usually, it is a practice to review the claims on a periodical basis such as weekly, monthly or quarterly which is very beneficial to analyze the effect of claims on the revenue cycle management and the financial prospects of the facility.
But, reviewing the claims on a daily basis has its own plus points and helps in improving the revenues of the facility. By reviewing the claims as and when they are processed and examining all the claims submitted on a particular day at the end of the day ensures that the claims process is being followed appropriately and analyzed for a better revenue cycle management. Incorporating a daily review of the claims submitted facilitates the billing staff and the management to understand the claims submission and reimbursement procedures in a better way and perform the processes in a manner that eliminate claims related errors. This should be one of the methods to be followed by RCM services for the improvement of the revenue cycle.
With this kind of daily review the RCM services providers can analyze why claims are being rejected or denied and what is the cause of delayed reimbursements. To maintain a healthy revenue cycle and increase timely reimbursements, a facility should follow some simple rules.
Scrutinize patient eligibility: The process of claims should start even before the services are provided. The facility’s administrative and front-desk staff should verify a patient’s insurance eligibility even before the services are provided. A very common reason for the claims being denied is the low coverage or no coverage for the treatment provided. So, it helps a lot to check a patient’s insurance eligibility prior to providing services.
Submit accurate claims: Ensuring that all the information provided in the claims is accurate and all the insurance details of the patient are correct before submitting claims will make the claims process much faster and hassle-free. RCM services professionals should take care that the appropriate ICD codes are given to all the billed procedures and services so that the claims are not denied on the basis of wrong medical codes.
Investigation for Claims resubmission: Even after taking appropriate measures if the claims are denied, it is necessary for the RCM services providers to trace the reasons for the denial and then only re-submit or appeal the denied claims. Without a proper investigation into the reasons behind the denial, the resubmitted claims will not be accurate and may result in further denial. Also, it is very important to track and follow up on the denied claims on a daily basis to avoid any dues for a long time.
For a healthy revenue cycle, it is important that the billing process is streamlined and the claims denials are minimized. For this, it is crucial to choose capable RCM services providers.