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Currently, due to improper staff training, a lack of intimate knowledge of payer-specific adjudication rules, and the use of legacy software systems that aren’t up to the task, your workflow is far from optimized.
If your practice’s workflow were better managed, individual claims would be quickly routed based on specific denial types to the most relevant and knowledgeable staff member.
However, because they don’t have a better way at present, each member of your AR team frequently calls payers one claim at a time to determine each specific issue. These “touches” often yield disappointing results. They also typically eat up a lot of time that could be better spent by:
- Re-submitting corrected claims after issues are resolved instead of leaving them sitting or dropping them to paper mailing
- Using appeals to challenge the payer when services are not covered
- Resolving other denial issues that need appealed
In short, your AR team wastes a lot of time, not because they’re not working hard, but because the workflow isn’t being directed properly.
This dynamic only gets worse with time. For example, maybe one member of your team just seems to naturally understand the claims process more so than other team members. When the head of your AR department needs something done quickly, they’ll likely approach this team member regardless of the type of claim and specific payer, when actually another team member would be better suited for it.
Because your AR department doesn’t have a way to ensure workflow is routed effectively and with precise intent, one or two people may be expected to become a master of every single issue. When actually, if the head of your department better understood each member’s strengths, your AR would quickly be whipped into shape.
Solution: Route AR to the Right Department
Many issues can result from a billing office not routing their accounts receivable workflow to the appropriate department. For instance, some employees may deeply understand one specific part of the workflow, but have limited knowledge that can be applied to an entire set of claims and denials.
You can solve this by continuing to organize their job responsibilities by function, but training your staff across departments so they can follow the steps and data of a claim from front end to back end. For example, this means that a person on a small team that manages patient insurance eligibility benefits deal with the front end, as well as, the back the end when there is an eligibility coordination of benefits or covered services issue.
Another issue cross department training addresses is if supporting documentation needs to be provided for a broad set of denials anyone – including medical and clinical staff involved in the coding process – can supply attachments or any additional information needed to support the claim. This will further streamline your front end workflow, maybe even making it possible to provide the necessary paperwork to the backend AR follow up team when the initial coding is completed.
Don’t just assume that your AR department is routing workflow effectively. Read up on how you can ensure the process is optimized by downloading our free eBook 10 Deadly Sins of AR and How to Fix Them. But don’t stop there. For further professional assistance in making your medical business work effectively and bring in more money, set up a consultation with the RCM Brain experts. Call 1-855-RCM-BETH or book online.