Converting accounts receivable into cash demands a well-organized, systematic and focused approach that is designed to facilitate problem resolution instead of just basic information gathering. Effective documentation facilitates vital reference material that can be very handy when analyzing and resolving problems that might emerge in the future.
Evolving Benchmarks by payers
Identifying claims outside the benchmarks
Prioritizing claims to work on
Identifying of problems
Preparing an Action plan
Implementing the solution for the entire outstanding claims
To understand the cash disbursement process followed by varied payers, it is vital to establish the benchmarks around their processing patterns. Information pertaining to this is typically gathered through historical data and other references, such as previously-issued Denial mails, EOBs (Explanation of Benefits) that were paid out, Manuals and Newsletters.
The benchmark information should clearly illustrate the following:
Note that processing and payment delays are not built into the benchmark, since these generally arise due to improper submission of claims documents.
We are committed to offer a well-planned system to deliver on the medical claims process, which includes the following steps:
Further to the benchmarks being established, we identify the medical claims that are outliers to the benchmark. This process is done on a weekly basis to determine the total volume and value of such claims. This helps in defining a broad pattern on the key issues impacting most of the claims.
Upon identifying the medical claims that are outliers to the benchmark, we next identify the claims that can be processed forward. Reports are used to identify the payer type and filing limit.
This forms a crucial step where problems and resolution approaches for the various cases are analyzed and documented. Since the medical insurance process is governed by complex regulations, insurance companies have devised complex rules for the claims payout process. Navigating through any errors-by way of erroneous data entry, incorrect claims information or external processing delay, will therefore need to be managed carefully. Each of the problems will need to be researched well and solutions will have to be identified, depending on the nature of error. The resolution approach is also applied to other pending claims of a specific carrier to ensure timely closure.
Once the problem pertaining to a claim is identified, the case is assigned to our calling team to confirm the findings and establish understanding on the reasons for claim rejection. We then prepare an action plan to determine ways for faster claim payment. An action plan will establish the necessary steps to be initiated, such as change of address letters, dispatching physicians' enrolment forms, corrected claims and any additional documents.
Upon drafting the action plan to address specific problems, we create a solution approach that can be applied across all outstanding claims that fit within the specific problem category.
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