3 min read

What Billers Should Know to Help Jumpstart 2016

By Prime Care Tech Marketing on Wed, Dec 23, 2015 @ 01:48 PM

Billers 2016 ClaimsValuable highlights from 2015 blogs to prepare for 2016

Hard to believe that 2015 is rapidly passing into history. Another year, but what a year it has been for Long Term Post-Acute Providers (LTPAC) providers especially considering the incredible number of claims billers have had to prepare, submit, monitor, and manage. We congratulate billers across the country for what they have been able to accomplish in converting claims to cash in the bank.

The primeCLAIMS team works just as hard to provide an excellent clearinghouse service and also to communicate worthwhile tips and advice to help make billing tasks easier to complete. Looking back on our blogs in 2015, we have covered such topics as ICD-10, processing secondary claims, dealing with claims rejections, principles of successfully Revenue Cycle Management, tips for submitting clean claims, and what to look for in a LTPAC clearinghouse.

Regarding secondary claims, one of our recent blogs, entitled, “What you’re wasting by processing secondary claims manually,” discusses the why’s of automation. The days of manually identifying, preparing, processing, and tracking secondary payer claims is long past. If they haven’t already, we suggest billers retire such costly practices forever and start the new year right.

Managing claims does not have to be complicated we argued in the blog, “Do yourself a favor - Simplify the reimbursement process,” if billers automate the process.

Not all clearinghouses are created equal. In “How well is your claims management solution moving cash flow,” we share some insight into what a clearinghouse, processing LTPAC claims, should offer. Further, because no matter how automated the process may be, claims is still about people. And people and machines need support. In another blog, we ask the question, “Clearinghouse support – is it there when you need it?”

These blogs represent the kind of information billers and their managers should know to be successful not only in 2015, but also in 2016. We look forward to continuing to share our insights and the experiences of your peers in future blogs. After all, it just makes cents.

For your convenience, we’ve grouped the recent blogs by category:

Topics

Related blogs

ICD-10

ICD-10 – It’s here. Now what?

Maintain a solid financial footing through the quagmire of ICD-10 implementation

Secondary claims

Taking the Headaches Out of Secondary Claims

What you’re wasting by processing secondary claims manually

The Importance of Using a Clearinghouse for Secondary Claims

Rejections

How to handle claims rejections

RCM

Mitigate shrinking margins with revenue cycle management

Do yourself a favor - Simplify the reimbursement process

Simplifying the Managed Care Claims Process

It’s the Holidays! How to have financial Peace of Mind at this busy time.

Clearinghouse

How well is your claims management solution moving cash flow?

Clearinghouse support – is it there when you need it?

Clean claims

Giving Payers a Clean Claim – 11 tips to getting paid faster

Happy Holidays! May this season bring you and yours joy.

Claims Process

Topics: revenue cycle management claims management clearinghouse LTPAC, Long Term Post-Acure Care, ICD-10 claims rejections secondary claims clean claims LTPAC providers billers managing claims
3 min read

How Well is Your Claims Management Solution Moving Cash Flow?

By Prime Care Tech Marketing on Fri, Dec 11, 2015 @ 06:58 PM

Claims Management Cash flowThat claims management has an impact on cash flow cannot be denied. But is your solution really working for you? First, let’s identify in what ways a claims management solution helps cash flow by converting into statements the questions found in our recent primeCLAIMS quiz, entitled, “Is Your Claims Clearinghouse a High Performer?”

Cash Flow

 

With your current solution you should be seeing cash flow improvements quarter over quarter. We suggest setting specific goals tied to claims-to-cash improvement and review progress at least quarterly. Contributing directly to cash flow improvement is measured improvement in your claims acceptance rate. The clearinghouse you choose should be able to help your AR team significantly reduce claims rejections conveniently. Occasionally, payers may request changes to the claims your team submits. A clearinghouse should help you turn those claims around quickly.

Take a close look at your clearinghouse and the middleware[1] it uses. We have learned from providers who use other clearinghouses that critically-needed application upgrades can take an unreasonably long period of time. Why? Because some clearinghouses do not own the middleware their application relies on and must wait for such changes. Owning the middleware certainly contributes to a quicker response to upgrade requests. 

We’ve mentioned this before, but with a clearinghouse experienced with post-acute payers and their claims processing technicalities providers are more likely to see improved claims processing and fewer frustrations. Such a clearinghouse is more responsive to LTC provider needs and in some cases the clearinghouse can anticipate needs and be ahead of the upgrade curve.

Productivity & Labor Savings

Considering turnover issues, the automated claims management solution needs to be intuitive - easy to learn and use for newly-hired and less-experienced billers. Further, with customized train-the-trainer programs and implementation, the clearinghouse helps providers to get new-hires up and running quickly while reducing orientation and training costs.   

The clearinghouse application must be robust with simplified reimbursement workflows and the users’ ability to manage claims submissions, denials, remits, DDE access, and HETS inquiries in a single portal. Further, being able to submit claims in batches reduces inefficient and costly steps. Should a payer reject a claim, the clearinghouse should be able to isolate the rejected claim and not reject the entire batch. Another example of possible key clearinghouse capabilities is the automatic identification and release of secondary claims. Secondary claims are a significant part of revenue to be collected yet are likely most at risk for non-payment.

Near and dear to any CFO’s heart are reports. Being able to view a dashboard of claims-related KPIs has proven valuable to provider management teams which can reinforce accountability throughout the entire claims management process.

Compliance

From a strategic standpoint, having a clearinghouse partner that keeps up with LTC-specific regulatory changes across the senior care continuum and communicates them to its provider partners is important. In primeCLAIMS, customers are able to view updates and notices in their dashboards – a convenient way to anticipate and prepare for changes.

Security

Being in total control of who has access to which features, functionalities, and reports gives providers the control they want over the claims flow process. Such security capabilities give corporate, region, and facility managers the flexibility they need to view all locations for which he or she is responsible in aggregate and individually.

Enterprise Effectiveness

Sometimes the term “enterprise class” is overused, but in the case of claims processing, this term is meaningful. With some clearinghouses, management can only view claims’ status one facility at a time. Being able to aggregate (at the corporate or region level) and drill down to specific facilities in one portal gives managers both a high-level and, if they choose, an in-depth view of pending, outstanding, and paid claims.

A clearinghouse should not only upgrade its application and best-practice recommendations based on regulatory and payer-specific changes, but also listen to current customer needs and requests to improve customer productivity. If the clearinghouse appears to be unresponsive or slow to respond, that should be a concern.

Conclusion

We recommend that you carefully evaluate your current claims management solution to see if it is effectively helping you move cash into the bank. It just makes cents.

[1] “Middleware is a general term for software that serves to "glue together" separate, often complex and already existing, programs. Some software components that are frequently connected with middleware include enterprise applications and Web services.” TechTarget, http://searchsoa.techtarget.com/definition/middleware, Margaret Rouse

Claims Process

Topics: automated claims management cash flow clearinghouse Medicare claims claims middleware claims submissions secondary claims reimbursement workflows application upgrades compliance security

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