Automating Your Claim Status Process
A recent study by CAQH estimated the healthcare industry could save 122 billion dollars through expanded automation of processes. The same report stated follow up on insurance claims range from 3 – 17 minutes per claim. By incorporating Automated Claim Status in your AR follow up efforts you can…
Reduce FTE cost by more than 40%
Project cash more accurately
Identify claims not present with payers
Prevent timely filing
Work denials more efficiently
Doing more with less has long been the mantra in healthcare revenue cycle. Post pandemic personnel challenges have made that truer today than ever. Decreased revenue cycle personnel and increased clinical personnel costs make automation in every area a necessity for financial health. The good news is MedCo can help reduce the FTE needs to follow up on insurance claims while increasing insurance collections.
MedCo has created RevSTAT™, our productivity tool with a suite of capabilities to automate and streamline AR collections. One of the most effective offerings is Automated Claim Status. RevSTAT queries over 1000 payers for the status of the claims submitted. Claims status queries can be customized as to which accounts are to be queried and at what frequency you want to check on the claims. Responses are then categorized into 4 main work flows.
In Process/Set to Pay
For providers with higher clean claim rates, knowing you don’t have to follow up on the majority of your claims is a MAJOR reduction in follow up requirements. Claims identified as in process or set to pay can be moved into an “hold category” until payments are reported via 835 data. Removing these accounts from the overall account population GREATLY reduces the amount of follow up required. Rules can be set to follow up on these claims only if they have not paid in a certain number of days. Visibility to claims that are set to pay allows providers to project their expected cash with a much higher accuracy.
Not Found
Many times, during follow up providers discover the payer does not have the claim in their system. Left undiscovered, millions of dollars are denied each year for timely filing. With personnel challenges being what they are, discovering these missing claims is more of a challenge. Quickly identifying missing claims is “low hanging fruit” when it comes to increasing collections and eliminates timely filing denials.
Denied
The bottom line is…denials don’t have to be so hard. RevSTAT reads in the denial codes and pragmatically places them in work queues for more efficient correction. Example: Denial Code CO16 is a very generic denial code used when information is needed or the claim contains an error. RevSTAT uses the associated RARC code which is much more descriptive as to the reason the claim was denied. By providing this granular information, the claims can be categorized together with other claims that have the same deficiency. Doing so makes denial follow up a much more efficient process; reducing the amount of investigation to perfect the claim and resubmit. Denied claims are placed into follow up workflows by denial codes. This speeds up follow up when personnel can focus on the same type denials instead of having to switch gears mentally between each denial. An additional benefit to filtering denied claims by denial code is IMMEDIATE trend identification whether internal or at the payer.
As we continue to face the daily challenges in healthcare, it becomes more obvious that automation is no longer a wish list item but has now become necessity. MedCo has three different automated claim status offerings depending upon your needs and your system capabilities. Ranging from transaction-based cost to subscription, MedCo has a plan to fit your organization. To find out how MedCo can help your organization benefit from automated claim status, as well as other automated processes, call 844-528-4338 to schedule an introductory call today!