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Denials of claims can occur all through the revenue cycle however, they usually begin in the beginning, when the patient is seeking treatment. In The Journal of SNF medical billing and coding the majority of errors made in the healthcare industry are administrative. This is not surprising when you think about the sheer volume of paperwork required by front-office personnel, and what is in many companies an overwhelmingly manual workflow.
Nursing home billing services found that patient charts aren't available on 30 percent of patients' visits. Without this vital information the basic information about patients and benefits eligibility details are not available and can result in claims errors and denials. But, it's not the only issue. For claims to be paid on time they have to be accurate, legible, and comprehensive, which is a huge task considering the complexity and number of diagnostic codes as well as the speed of regulatory changes.
Denials are more expensive than you imagine
Nursing home billing companies' process of recovering revenue lost is a long and costly process, however, it is worth the effort for businesses. The second quarter of 2016 saw the median automated denial of claims from the Medicare Recovery Audit Program was worth. and complex denials that needed medical records were reviewed on average least, according to the American Hospital Association.
With so many stakes, preventing errors from occurring at all, and avoiding claims that are denied is the most effective strategy. But how do you do it? The first step is to identify the main reasons why claims are not accepted:
Humans make mistakes.
Humans make mistakes and, at times, we fail, no matter how competent we are at our job, or how amazing we are as individuals. If you combine our human nature with a complex healthcare system that's always changing, it's no wonder mistakes occur. But that doesn't mean we can't refrain from seeking out a better solution to manage this procedure.
It's a simple fix
There's a good thing: the majority of revenue lost during the revenue cycle can be avoided by automation. The majority of claims that are rejected don't necessarily have to be denied.
A computerized system that has an integrated claims scrubber along with custom business rules as well as eligibility checks prior to submission can assist in making sure that your claims are as clean as possible. It will also be up to date with the latest diagnostic codes so that your staff doesn't need to.
The value you give patients directly impacts the money you make. This is true for any healthcare provider However, nursing home billing is unfortunate that not all healthcare providers are aware of the effect that the satisfaction of patients can have. The more content your patients are satisfied with, the better the performance of your revenue cycle management will be, which impacts the other aspects of your company.
The high cost of low satisfaction with patients
Patients are looking for transparent pricing and expectations for payment. They also are looking for:
An in-depth understanding of their situation
The steps that they should implement to improve their overall health
Simple, easy, and stress-free payment procedures
The possibility of tackling high costs for treatment is to use an installment plan
These things demonstrate to patients that they are truly cared for. If providers offer these services or payment choices, patient satisfaction rises. If these options aren't offered in care, they are more likely to be unhappy.
When satisfaction is low there are many areas of your company that are affected like profitability as well as market share and even the quality of your care. Patients who are unhappy tend to be less inclined to cover their medical expenses in full, or at any time.
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