Improve your bottom line by ensuring all insurance accounts are being managed

Industry analysts agree that healthcare staffing shortages aren’t going away anytime soon.[1] Some are even predicting that increased labor costs will cause expenses to outpace revenue growth.[2] That’s not good news for health systems and physician organizations.

As providers work to overcome these challenges, they should consider options that reduce stress on existing staff while improving revenue opportunities. Outsourcing can be a great option when revenues are being squeezed.

One strategic approach is to take a fresh look at areas you may not have considered outsourcing in the past. The situation is different for every organization. What might not have made sense to outsource in the past might be beneficial now given the current state of the industry.  One such opportunity to consider is the high volume of insurance accounts that have been left unmanaged by depleted or overworked staff.

Successfully converting receivables into bottom-line revenue is somewhat of an artform. If your organization relies purely on manual reimbursement processes, you’re likely focused on working accounts with the highest balances. Smaller accounts get pushed to the back or, worse yet, written off. Small-dollar denials – especially those under $5,000 – are often considered more work than they’re worth.

Now that revenue cycle staff is in such short supply, many insurance accounts are being left unmanaged. In these challenging times, however, health systems and physician organizations need every dollar they can get.

There are several ways to effectively outsource A/R and denials. If you have sufficient staff but have fallen behind during the pandemic, outsourcing your backlog can help. Existing staff can focus on staying current while your outsourcer can bring aging accounts and denials up to date. For those that are struggling with a shortage of insurance reimbursement staff, outsourcing all accounts and denials under $5,000 may make more sense. These accounts, taken together, add up over time.

If you choose to outsource, there are four capabilities you should look for to ensure you receive the optimal return on your outsourcing investment.

Tenured staff. Make sure the vendor you choose has highly skilled staff with extensive experience. Payer rules are constantly changing and a lack of knowledge in this area can lead to increased denials and write-offs. The best vendors will have a team with deep knowledge of all payers—government, commercial and private. They should also have experience with third-party, worker’s comp, and motor vehicle claims.

Be sure to ask about their certification, training, and education programs as well as their average tenure. If the vendor has a high turnover rate, it may signal a problem with the company’s culture or management style. They should also have a clearly defined quality assurance and process improvement plan.

Automation technology. Working denied claims is challenging no matter their size, especially when using manual workflows. Besides being time-consuming, manual processes can lead to increased errors. The result is delayed or denied reimbursement. The best vendors should use exception-based workflow automation. For example, 835 denial routing and automated claims status help vendors work more effectively, which results in faster reimbursement and greater ROI for you.

Analytics. The best denial is the one that never happens. Even with smaller balance denials, the vendor you choose should be using analytics with 835 automated crosswalk to CARC. This should include root-cause analysis and prevention assistance. Leveraging this information, your vendor will have the information needed to create more effective appeals. Denial analytics also help identify opportunities for improving processes that can reduce denials overall – large or small.

Predictive AI. Artificial intelligence (AI) is gaining traction in revenue cycle processes and for good reason. When it comes to reimbursement workflows, AI can identify accounts that are most likely to be paid and denials that are most likely to be successfully appealed. This is important as it allows your vendor to better prioritize which accounts to work first. Even in small balance accounts, this level of efficiency is important and helps ensure the best return on your outsourcing investments.

Preparing for the road ahead
Even if you did not consider outsourcing in the past, it is time to revisit. Staffing shortages have significantly impacted revenue cycle operations and are predicted to continue for the foreseeable future. A wise approach is to identify opportunities to alleviate staffing challenges within existing processes. Outsourcing part of your A/R is a great place to begin. Your staff benefits by having less stress while being more productive, and your organization benefits by improving cash flow and reducing write-offs.



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