Healthcare providers struggle with receiving payments on time and dealing with claim denials, which only seem to worsen with time. The problems are further exacerbated by the never-ending advancement of technology in healthcare revenue cycle management. Availity, a reputed expert in information exchange in the healthcare industry, provides solutions to these very problems and helps track real-time claims. This article delves into how healthcare organizations can improve their revenue cycles in 2023 using Availity’s claim-tracking tools and denial prevention strategies.
Lack of Streamlined Processes in Revenue Cycle Management
The most pressing challenges healthcare providers face involve:
High Claim Denial Rates: Claims can get denied for many reasons, including but not limited to inaccurate insurance data and failure to obtain prior authorization.
Delayed Reimbursements: Handling payment delays through manual processes lacking real-time oversight is problematic.
Resource Constraints: With fewer personnel, more administrative duties become increasingly difficult to file claims as efficiently as need be.
Meeting these challenges requires a proactive approach with the usage of technology to improve accuracy and streamline previously convoluted processes.
Real-time Visibility and Efficiency Availity’s Claim Tracking provides
Claim tracking tools from Availity help providers with:
Error Corrections Immediately: Timely identification and rectification of errors for frequent claim submissions mitigates denial issues immensely.
Uniform Standard Correction Processes: Workflow standardization promotes increased efficiency in claim issue resolution.
Comprehensive Analytics: Active monitoring of error tracking ensures continuous improvement to the claim management processes.
Integrating these tools allows providers to improve cash flow while significantly reducing denial backlogs.
Denial Prevention Strategies: Proactive Approach Instead of Reactive
Managing denials happens after they occur for a majority of organizations. Availity wants you to think differently:
Automated Eligibility and Authorization Checks: Verifying insurance coverage and authorization needs before service delivery mitigates the risk of missing/incomplete information at the claims stage.
Advanced Real-Time Eligibility (ARTE): Comprehensive eligibility information is retrieved and provided in a single transaction rather than multiple queries, which tend to increase errors.
Incorporating the above approaches will diminish claim denials and greatly optimize revenue cycle performance.
Employing AI with Predictive Editing
Artificial Intelligence is used Availity’s claims editing tool to:
Real-time Analyze Claims: Each claim is reviewed during creation with accurate denial prediction capabilities.
Provide Feedback Immediately: Guidance returned via API aids claim issue resolution pre-submission, diminishing post-claim submission manual analysis.
Complex Adaptation: Uses sophisticated payer-specific edit scenarios to augment the performance of other editing tools.
Proactively reducing the administrative burden expands claim precision and improves reimbursement rates.
Step-By-Step Medical Claim Management Readjustment
Claims made after payment for services are optimally handled to enhance prompt payment processing. Availity has effective solutions, such as:
Claim Submission: Adapting to automated submissions eliminates cost inefficiencies linked with paper submissions.
E-Remittance Processing: Streamlined payments are facilitated through the receipt of ERA files because payments will not need to be re-entered.
Enhanced Claim Visibility: Claims that have automation tools allow for the thorough tracking and monitoring of issues with regard to their resolution.
Health service providers stand to gain from these innovations as they reduce the workload while achieving faster payments.
The Use of Business Intelligence Tools in Medical Claims
The collection of data drives every known activity in the health revenue cycle. With reporting and analytics done through Availity, claims tracking becomes:
- Near-Real Time: Actionable real-time tracking gives timely feedback, which can nip problems in the bud before they escalate to delays or denials.
Scheduled Custom Reporting: Routine number-crunching reports enable tracking of performance against a target, making it possible for specific areas to be tackled.
Timely claim denial diagnosis creates the needed adjustments for a proactive approach to the processes that address the claim denial or delay pattern.
Process Automation based upon the insights can improve the claim payment cycle efficiency.
The Consolidation
The complexity involved in the RPM requires providers to adopt more advanced technologies in order to meet the dynamics of the industry. Claim tracking and denial prevention through AI-enabled predictive editing, strength analytics, and reporting create better efficiencies while wading through claim paperwork.
Providers can improve their financial outcomes as well as enhance patient satisfaction through accurate and timely billing when they shift from reactive to proactive strategies.
