In a competitive digital and automation edge, assuming business without the potential technology to its function may not yield success. A more significant period in general and COVID-19 have witnessed a considerable shift towards certain effective technologies for innovative functionalities and efficient revenue.
Managing claims in healthcare has been a significant challenge across ages, and practitioners are after strategies to effectively manage claims, find out the causes of denial, and reduce denial rates to ensure overall improvement in the practice. According to the AAPC, the top three reasons for claims denials are incorrect or missing patient information, patient not covered, and service not covered. However, automated eligibility software can adequately address all these issues.
Healthcare and insurance providers, in terms of identifying and analyzing claims, have gotten a more accessible track to cater to the issues from minor to major. Practitioners have changed the way to assess and manage claims for insureds. Technology is credited for enabling healthcare professionals and insurers to leverage analytics to identify and Artificial Intelligence for optimizing claim management according to the practice requirement.
What is claim denial management in healthcare RCM and medical billing?
Claim denial management in healthcare revenue cycle management is responsible for analyzing, investigating, and resolving denied insurance claims. Denied claims cause physicians considerable yearly loss. However, skilled denial management can reduce the risk of lost costs. They can reduce the claim denials and improve the overall cash flow for the practitioners.
There is no need to invest in specific training or spend much time handling intricate medical billing; find the right medical billing company and ensure a smooth revenue potential of as much as 30%. Outsourcing medical coding and billing will help you pay for quality care to your patients and get paid faster for the services provided.
Reducing claim denial management with AI and Automation
Ensuring accurate eligibility
Automapotentially positively impacted the healthcare practice from the first patient interaction with the hospital and generating ROI. Along with lessening the denials and improving the accuracy of the revenue cycle, AI-automated benefits reduce registration and eligibility issues, causing 23—9% of claims. Many problems occur due to changes in coverage, schedules, and appointment activities, or the cause of denial results from inaccurate benefit information in EHR. Since intelligent automation significantly develops your real-time eligibility checks by checking coverage frequently, your practice can ensure a streamlined approach and improved revenue.
Healthcare practitioners deal with claim denials mainly because of medical necessity issues and prior authorization. With the growing number of prior authorizations, it is likely to increase the number of rejections. The professionals must take practical steps to cover the issues, and prior approval is one of the most labor-intensive and time-consuming processes in the hospital revenue cycle. However, the automated AI-powered prior authorization solution resolves the issue of denial by automating several steps in the practice. These include determining the need for prior authorization, helping submit prior auth requests with data from the records stored in EHR, and continually checking prior authorization status. The practitioners can enhance their error correction process for future denials this way.
Claim status checks
The manual procedure of claim checking takes an average of 14 minutes, precisely when you are to consider the number and frequency of these checks. Apparently, it becomes impossible for human integrity to check these because it’s notified as a simple and repetitive procedure suitable for automation.
Recently, 48% of claims to be worked have yet to be worked. Professionals, after analyzing how automation can reduce denials without spending much time reworking denials that could be covered and without paying attention to improving other procedures in the revenue cycle to prevent denials at first.
Hence, automating the process of claim status checks in dental billing may not necessarily reduce the frequency of denials but can certainly save a significant amount of staff time. This time-saving allows staff to reallocate their efforts to other critical steps in the revenue cycle process, including efficiently reworking denials.
AI-powered denials management
Once denied a claim, AI technology systems can efficiently recover more denied claims. AI-powered denials management is the first step, which starts with automated claims status checks. From fixing simple errors and resubmitting a denied claim, artificial intelligence covers more complicated errors by passing the denials to a human and providing detailed information on the patient and denial, speeding up the rework. AI-integrated denial management systems work contradictions and collect available reimbursements to increase ROI and reduce A/R days.
Deep learning insights into denials
Healthcare professionals benefit from analyzing the data behind the claim process with AI. These insights help future decisions in improving the claim process. One of the health systems evidenced the cause of one drug denial due to missing prior authorizations and medical necessity. Analyzing the information helped the practitioners gain insight into opportunities for process improvement and methods to resolve the issue.
Don’t let the denials influence your practice – leverage the simple and efficient tech solutions.
Almost 90% of denied claims are avoidable, and 50% to 65% are never reworked, leaving a massive amount of money on the table – money that could help hire new staff, improve the office, and replace outdated technology. Moreover, reworking a denial costs $25, does not encompass time and overhead, and increases the impact.
Avoid underestimating the impact and take simple and efficient technology solutions to improve the multiple-stage denials and claim management process.
How AI-Modeling can maximize the revenue for healthcare?
Modeling and automation help practitioners save time and money by reducing preventable denials in several ways.
Maximize revenue with eligibility checks and prior authorizations
Providers can check and verify patient data to ensure medical necessity at every touchpoint with electronic prior authorization prompts as automated solutions ease pre-authorization, access necessary documentation, and provide real-time authorization status reports.
They can automate inquiries and authorization checks with health’s online prior authorization workflow. The solution is to simplify pre-auth submission with multiple payer connection types. Moreover, the user can access the right portal for faster, more accurate recommendations.
Set up recoverable claims
The approval of multiple minor claims can influence the provider’s bottom line more than denying a higher-value claim. So, there must be an appealing strategy.
Health’s AI denial solution helps staff set profitable resubmissions by automatically categorizing denials likely to be approved. Professionals can efficiently use it with predictive denials to maximize reimbursement. These predictive denials help claims at the risk of denial so staff can inquire about these before submission.
Staff can reduce the stress of repetitive tasks.
According to CAQH, automation saves 22 minutes per claim, consuming much time and expense.
However, healthcare professionals can enhance efficiency by using AI to handle repetitive tasks at scale and perform complex analyses. At the same time, employees focus on reworking claims likely to realize revenue in claim management.
The bottom line
Although AI technology is new for businesses to integrate efficiently and in healthcare specifically, its efficiency, intelligence, and accuracy can potentially reduce claim denials. By skillfully using the technology to its potential, providers can recover claim management and healthcare revenue. Just remove the stress of intricate claim management and denials, but focus on the effective strategies to employ the technology to the best of your practice.