Streamlining Claims Management

Effective payer provider collaboration is key to reducing the cost of healthcare, and claims management is an integral component of that relationship. As many organizations focus on care management, they must also streamline claims management processes to evolve with changing reimbursement models. Training and new technologies are at the core of claims management improvement. Technology continues to play an ever-increasing role in collecting patient data and ongoing training ensures personnel stay current with claims management trends.

Advice for Payers and Providers

Even with these new technologies, executives and middle managers continue to struggle with efficient reimbursement. Technology is only one part of the answer. Other hands-on solutions should be implemented as well. Some examples include:

  • Understand documentation and processes – Ensuring staff have a clear understanding of required documentation and that what is submitted is comprehensive may seem like a small thing, but it can have a significant impact on timely processing and payment being received. Processes should be thoroughly examined, refined, and then documented. Complete and current process documentation is critical to ensure continuity when there is staff turnover.
  • Examine the root cause of claim denials – Claim denials have a negative impact on the revenue cycle and increases operating costs to reprocess. It is important to have a clear understanding of the root cause for all denials. For example, many claims are often denied for untimely filing and this can be resolved by implementing processes to ensure deadlines are maintained.
  • Leverage portals and websites to address data inaccuracies – Patient portals are becoming an increasingly common to tool to help overcome the challenges associated with inaccurate and incomplete data. By allowing the patient access to their personal medical records, they can verify information and may feel more engaged with their care.
  • Automate to reduce errors – Leveraging technology to automate workflows will result in fewer mistakes and significant cost savings. It is estimated that commercial healthcare payers and providers could save over $11 billion annually by doing away with manual processes.
  • Data sharing between payers and providers to resolve and reduce claim denials – Investing in technologies and training will help providers and payers share data with greater efficiency and improved delivery of care.

Payers and providers need more than just technology to streamline medical claims management and may lack the expertise to have an impact in their organizations. However, with appropriate guidance and resources, medical claims management can be streamlined resulting in cost savings, increased productivity, and improved quality of care.