For some insight on how reconfiguring your software could help bring in more money and boost the growth of your medical business, download our free eBook 10 Deadly Sins of AR and How to Fix Them.
Whether your medical business uses practice management or clearinghouse software, there are many different settings possible. The system may have been implemented incorrectly from the start or – perhaps even more frustrating – the software may have been working just fine but is now causing denials because it needed to be reconfigured at some point and wasn’t.
When these software setup problems occur, incorrect values can go out on claims that are somewhat unseen by your billing team members. The majority of the time, these software systems have settings that would be able to enforce payer-specific data entry requirements when creating and submitting a claim. It’s just that these capabilities aren’t being taken advantage of currently, ultimately resulting in denials.
You may think that your team should be able to notice and address these issues, but these software systems are extremely complex. Also, at present, your staff members do not receive an intensive training around the software and the processes that they’re expected to follow.
Some clearinghouses can add rules and edits within their software that will:
- Prevent a claim from going to the payer if it does not meet certain criteria
- Automatically fix elements of the claim to account for payer-specific adjudication nuances before submission
But, depending on the software your medical business is using and how well it’s setup, there’s a very good chance that claims are going out the door without being tailored for the payer they’re heading to. For example, your AR department may treat three claims destined for Blue Cross Blue Shield, Humana, and Medicare identically, even though each of these payers require slight nuances in order to consistently get paid correctly.
Ultimately, these errors and oversights result in time-consuming and often fruitless AR follow-up work when claims are denied or underpaid. These sorts of issues will only get worse as payers increasingly require supporting documentation and attachments for claims.
Solution: Resolve Your Software Setup Troubles
Workflow is one of the biggest areas of confusion and frustration and never-ending complexity that plagues billing offices.
One major concern is that the revenue cycle industry is full of legacy software systems that are firmly embedded inside:
- Medical practices
- Ancillary services
- Reporting applications
- Clearing houses
- Intermediary clearing houses
- Payer web portals
Unfortunately this software frequently:
- Frustrates users
- Results in underwhelming productivity
- Causes issues that ultimately create denials due to incorrect settings or a lack of application of settings in the software
However, if properly setup, upfront data entry requirements can be made payer-specific, ultimately resulting in fewer denials.
Whether your AR team uses a practice management system or a clearing house one, you should be able to either:
- Automatically prevent incorrect data entry
- Scrub claims for incorrect combinations of data, ensuring they’re correctly coded and entered before heading to specific payers
Make sure your software is working at full capacity to help your AR department avoid denials and get claims paid. For more about this issue and nine others that are hindering your medical business, download our free eBook 10 Deadly Sins of AR and How to Fix Them and call the RCM Brain experts at 1-855-RCM-BETH. We also have a simple online form you can use to schedule your consultation.