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4 ways to reclaim the claims process

In an era when the healthcare community is working to improve quality of service and delivery and to reduce costs, the reimbursement process is under intense scrutiny. Organizations are asking themselves: How can we simplify the claims process? Are there ways to save time? What can we do to make our claims more accurate to help speed payments?

In a series of recent case studies, three clients have shared their experiences using Allscripts Payerpath® Solutions to reclaim their claims processes. Here are four examples:

1) Collect more patient payments

Patient payments are the fastest growing portion of many providers’ revenue streams. Unfortunately, according to the American Hospital Association, as much as 5.3% of expenses are written off each year as uncompensated care, representing $42.8 billion in losses.

One of the ways Burton Creek Rural Clinic (West Plains, Missouri, U.S.A.) is increasing collections is to confirm patients’ insurance eligibility at the front desk. “Payerpath is helpful in obtaining co-payments and co-insurance. It provides up-to-date information for plan coverage,” Administrator Sonja Stauffer said.

2) Scrub for a cleaner claims rate

Every claim rejection or denial is a risk that the practice will not get paid for services rendered. Studies show that the average cost of reworking a claim is $25, and 50% to 65% of claims are never reworked. But there are ways to check claims and “scrub” any errors before submitting them to payers.

North Florida OB/GYN Associates (NFOB) (Jacksonville, Florida, U.S.A.) improves its clean claims rate by applying technology to every step in the claims process. “With all the tools we have in Payerpath to scrub claims, we have a 96% clean claims rate,” Practice Management System Manager Priscilla Brinson said.

3) Reduce manual processes

Electronic posting can help eliminate missing information, incorrect codes and data entry errors that result in rejected or denied claims. Adult & Pediatric Orthopedic Clinic (Vernon Hills, Illinois, U.S.A.) made the switch to Payerpath, Allscripts Professional EHR and Allscripts Practice Management in 2009.

“All payments were posted manually before we implemented the Allscripts Payerpath system,” Business Office and IT Administrator Joanne DeGennaro said. “Now we can post payments electronically, check status of denied claims, pull up EOBs [Explanation of Benefits]…the staff seems to like it.”

In addition to remit payment posting, transactions from other Payerpath Patient Responsibility Solutions including Payerpath Receipt and Payerpath eStatements will electronically post to the practice management system.

4) Keep employees up to date

Once a practice starts using a solution to manage the claims reimbursement cycle, it’s important that staff has training to get the most from technology. Training options should be available to new staff, and to staff that may need to understand an upgrade or a new feature.

“We like to use the knowledge-based center videos to train new staff, learn about upgrades or just use the resources there as a refresher,” Brinson said. “It’s a great way to learn.”

To learn more about these clients and their experiences with Payerpath, download free case studies here. Payerpath clients can also access videos, articles and other helpful resources on ClientConnect.

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