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David Brooks

David Brooks

4 Top Tips to Lower Your Claims Denial Rate

4 Top Tips to Lower Your Claims Denial Rate

In recent times, the claims denial rate of many practices has risen to unsustainable levels, soaring well above the industry standard of about 3-5%. The implications of high claims denial rates for a practice is far reaching as it hits at the core of revenue cycle performance; negatively affecting cash flow and dragging revenue growth. However, this does not have to be your center’s experience. Your practice can significantly reduce claims denial rates and witness a revitalization in revenue and cash flow growth. Here are 4 tips to help lower your denial rate: 

1. Analyze the Causes of Your Denials

The first step to take in reducing denials is to conduct an analysis of your present denial rate and identify the primary reasons for the denials experienced by your practice. While reasons for denials vary in each circumstance, it’s important that you discover the root causes of denials. You might want to look at your current processes, your staff, or your technology stack to get to the root cause. This is very crucial because adopting strategies of high performing practices might not result in any significant improvement in your denials rate if the root causes of denials are not identified and addressed.  

2. Minimize Coding Errors 

Errors in coding represent one of the greatest cause of claim denials for practices. Previous and newly developed codes must therefore be verified to ensure they are free from errors. To achieve this, a practice might have to employ the services of expert coders and billers if it lacks expertise to handle it in-house. Expert coders and billers will be a great addition to your staff as they will help fix coding and billing errors that cause loss of revenue.

3. Educate Your Staff

Education and training of your staff on effectively managing claims collection and denial processes should be given top priority by your practice. Many claims denials can be avoided if employees are trained on the best practices. Significant training should be given to employees to ensure accuracy of data collected from patients as this forms the foundation of a best-in-class claims management. 

4. Create a Claims Denial Unit 

Creating a unit specifically dedicated to claims denial management will help your practice reduce its denials rate significantly. Operational efficiency is easily achieved when a unit in your practice is saddled with the responsibility of identifying, resolving, and proffering solutions to the causes of claims denials unique to your organization. This team should comprise physicians, coders, billers, software development experts, medical researchers, and members of the top management.

Education & Innovation Needed from Providers to Boost Millennial Medical Bill Payments

  • December 20, 2017
  • Published in Billing

Credit Bureau TransUnion released a new report recently that points out that the healthcare industry needs to not only simplify the medical bill paying system, to be innovative, and help patients understand their health insurance benefits if they are ever to get millennials to pay their medical bills on a consistent basis.  

This report from TransUnion pointed out that nearly six out of every ten millennials, or about 57 percent, had either no understanding or very little understanding of their health insurance benefits.  The group known as gen X was found to have about 50 percent who said that they had little or no understanding of their benefits while only 41 percent of the baby boomer generation claimed they had little or no understanding of their health insurance.

Another noteworthy finding from the survey was that even though most millennials do have health insurance, it typically takes them longer to pay for their medical services than it does for other generations according to TransUnion.  One reason for this is thought to be transparency in the billing process as well a lack of notification pertaining to out-of-pocket costs by insurance companies prior to treatment.  

The TransUnion report also points out that 46 percent of millennials polled said they would that the likelihood that they would pay for their medical services would be greater if cost estimates were given at point of service.  It appears that education surrounding their approach to health insurance options would be helpful to them.  The report showed that 26 percent of millennials were happy with high deductible health insurance plan options, whereas on 17 percent of gen X chose these plans and only nine percent of the baby boom generation chose such plans.

“Providers should be looking for opportunities to improve cash flow coming from millennial patients to continue thriving.  At Mnet, we have live agents who are more than happy to work with patients to help educate them about the healthcare process and how their health insurance policy works.  We have found that this drastically enhances the patient experience” said Mnet Health CEO David Hamilton.

Another interesting point that came from the TransUnion report is that millennials are the most likely to compare costs for healthcare with a full 40 percent saying that they have shopped rates whereas only 29 percent of gen Xers and 22 percent of baby boomers have shopped around for servicing costs.  

While it’s true that baby boomers are the most likely to have medical needs and the high costs related to those needs; it appears possible that a campaign aimed at educating them about the value of shopping around for services could likely create a change in their spending.  Generation X could also benefit from comparing healthcare costs as well.  Meanwhile, transparency in pricing for services is likely to add to the numbers of those who shop pricing for healthcare services.

New Report Shows Growth in Healthcare Prices Near All-Time Low

In the past year, from September of 2016 to September of 2017, healthcare prices have risen a scant 1.1%, which is the slowest rate of growth in the past two years according to a new report from Altarum.  That rate of growth is just barely higher than the all-time low of .9% which happened in 2015.  Since that point in time, that number has fluctuated between 1.2% and 2.3%.

The report points out that such a small increase in healthcare prices was likely due to a drop in prescription drug prices recently.  Growth in prescription drug prices has dropped to 1.4% in September from 2.7% in August.  

The report also found that total healthcare spending was 4.3% higher in September in comparison with the same month the previous year.  The expected growth of the healthcare industry for 2017 is forecast at 4.5%.  This rise in healthcare spending is viewed as modest in an industry known for heavy spending.

At the beginning of the century, in the early 2000’s, growth in healthcare spending was normally about 10%; however, the numbers have been declining significantly in recent years.  One reason for such a dip is likely the move from inpatient care previously to an outpatient setting according to analyzation from the creators of the Altarum report.

Publishers of the report point out that the trend in healthcare is moving away from inpatient healthcare and toward the outpatient care model.  Even employment numbers are demonstrating the same trend.  Hospitals have recently slowed their hiring this year in comparison with recent years.  On average, hospitals are likely to add about 5,000 new jobs per month in 2017.  This is about half the hires in the previous two years based on data from the report.

One report analyst pointed out that the slowdown of hiring at hospitals could simply be a return to previous healthcare industry patterns after several years of strong hiring gains resulting from the implementation of the Affordable Care Act (ACA).  Another analyst pointed out that a slowdown in hiring is most likely the best way to control healthcare spending because that is typically where most of the money is spent; payroll for employees.

Apple & Amazon Quietly Begin Move into Healthcare Sector

Until recently, Amazon’s new lab at its headquarters in Seattle was a secret.  It was set up to identify business prospects within the field of healthcare; prospects such as telemedicine and EHR’s.  But Amazon is not the only company seeking to make moves into healthcare.  Rumors that Apple is in talks with healthcare organizations and hospitals to unify health records onto their iPhone have recently been confirmed.

Reportedly, Apple has been in talks with Crossover Health, a company based in Aliso Viejo, California (also home to Mnet Health).  Crossover is a startup that works with employers who are self-insured to provide them with medical services at clinics that are onsite.  This move has stoked the fires of speculation concerning Apple’s move into the healthcare arena.

While negotiations apparently continued for several months, they did not result in a deal ultimately according to one unnamed source.  Others have mentioned attempts to strike a deal with One Medical, a concierge primary care organization based in San Francisco.  Tim Cook, Apple CEO, has publicly expressed an interest in business opportunities represented within healthcare.  An interview in Fortune magazine in September quoted Mr. Cook as saying “There’s much more in the health area.  There’s a lot of stuff I can’t tell you about that [Apple] is working on…I do think it’s a big area for Apple’s future.”

Apple has hired several healthcare experts and consultants in the last few years.  The giant tech company has also collaborated with researchers from Stanford to improve its digital health software while also make the iPhone the right place to go for patient health information.  Two software tools have recently been released by Apple; the Apple HealthKit and ResearchKit, which were designed to share patient health information with developers and also to recruit patients for clinical studies.

Meanwhile, Amazon is currently developing an EHR platform, telemedicine options, and health apps for devices such as the Amazon Echo.  Amazon is said to call its covert team “1492,” which, of course, is the year that Christopher Columbus first sailed to the Americas.  Another interesting tidbit is that positions for this team can be searched using the keyword “a1.492.”  They are also working on healthcare apps for devices such as the Echo and the Dash Wand.

In other apparently related news, President Trump recently announces that the CEO of Apple, Tim Cook, has promised that his company will build three large new manufacturing plants in the United States.

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