Tackling the primary challenges of health care claims processing

Tackling the primary challenges of health care claims processing

For any health care provider, processing all claims received in any given billing period, even a fairly slow one, is a considerable task. During particularly busy times of the year, the number of transactions and the associated patient and payer data can overwhelm your billing department. 

"Record-keeping mistakes that would be innocuous in many companies can be much more serious in health care."

Let's examine the major challenges that can arise from insurance claims filing and processing and how you can mitigate or eliminate these issues with ARDEM's data entry outsourcing services.

Minimizing costly errors
The circumstance detailed above may simply seem like part of any business's ebb and flow. Yet in this sector, complexities arise if the number of claims reaches a certain level and becomes a burden. Record-keeping mistakes that would be innocuous in many companies can be much more serious in health care. They might cause patient to be incorrectly billed, or create a conflict between a provider and an insurer, damaging relationships and adversely affecting everyone's bottom lines.

Consider this: PracticeSuite pointed out that something as small as a single incorrect claims code digit, such as 401 instead of 401.0 – the exact denotation for malignant essential hypertension; 401 is the overall hypertension category – could invalidate the entire filing. Missing information causes this problem as well, most frequently illness onset or accident dates that claims management teams fail to enter.

According to RevCycleIntelligence, this issue can become especially pronounced for health care providers with fewer resources, like small community clinics or private practices. Nalin Jain, delivery director of advisory services for the consulting firm CTG Health Solutions, elaborated on this point:

"Physicians are running the business, but they're not businessmen," Jain said. "They are caregivers, yet they have to manage their practice as a business and claims processing was the sand in the gears of practice management."

Handing the reins of this task to ARDEM eliminates such complications. Our document scanning and processing services can take on the lion's share of claims and billing needs, leaving a small-staffed practice free to focus on its patients.

Upholding compliance requirements
Between state and federal guidelines, health insurance is among the most regulated sectors of American business. Falling behind in certain compliance obligations happens from time to time, but health care providers must immediately address these gaps.

Because of this issue's importance, hospital and clinic administrators must delegate claims management responsibilities accordingly so that the most complicated, high-value accounts receive the greatest amount of attention. But claims and accounts that might, all things being equal, be considered routine don't simply disappear.

Allowing a backlog of unfiled, low-priority claims to mount could easily lead to your billing team rushing to fix the problem retroactively, failing to double-check each claim and down the road finding that an incomplete or otherwise mistaken portion of a filing doesn't comply with government regulations. For example, according to PracticeSuite, all Medicare claims must be turned in no more than 12 calendar months after a hospital or practice provides care to Medicare-eligible patients. The Centers for Medicare and Medicaid Services denies all late submissions.

Outsourcing the data entry tasks required for all certain filings to ARDEM can allow a hospital or clinic's staff to give payers with the most attendant compliance issues, such as Medicare and Medicaid, the meticulous diligence they require without causing logjams for other billings. ARDEM's solutions can ultimately lower costs and error rates to ensure health care providers remain compliant and maintain optimal levels of patient service.

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