If this falls within the reasonable realm of plausible possibility, I have to scratch my head and wonder why. Why place your business and your future at risk, when you don’t have to? Once again, IT can come to the rescue. Imagine the peace of mind you could have while reducing your DSO, assuming you are at risk not for lack of integrity, but credibility, if your organization had a billing and claims management system that would file clean claims each and every time.
Such an automated revenue cycle management system exists, specifically designed for long term care providers. Imagine a system comprised of a comprehensive and configurable user-friendly web portal to manage claims throughout the submission process, with functions for loading, reviewing, editing, and tracking claims online. With this portal, providers can fully leverage enterprise-level security and permissions with user-definable roles to satisfy their specific claims processing practices. As part of a complete health care transaction solution, providers can submit, monitor, edit claims, and review their claims on-line.
Key benefits of the ProClaim Partner’s application:
Smoother claims flow through direct connections with providers, trading partners, and value-added networks
Eliminating avoidable payment delays by increasing successful first-pass rates, tracking claims, and automatically checking claim status
Reduced transaction fees and paper handling costs by enabling direct connection with providers and payers
Decreased operations costs through automated handling of routine questions and documentation requests associated with eligibility, claims status, and referrals
Preserving investments in existing systems by offering an off-the-shelf claims management application that easily interfaces with existing adjudication, financial, and membership systems
Reduced risk through its robust user audit functionality
Providers would be well rewarded for looking into it. In times like these and under this “gotcha” environment of fraud crackdown, doing billing right certainly has its virtues. But a system is only as good as the workflow that leads to the filing of claims – preadmissions screening and documentation; admissions documentation; clinical documentation; therapy services documentation; proper coding; charges compiled; and claims created, scrubbed, triple checked, filed, and monitored. All are critical components of the workflow and are at risk of vital data and information leakage.
In the next blog, we’ll discuss some of these workflow components which are considered industry best practices.
Question: What solid claims management practices have you observed or implemented?