In our work assisting medical facilities improve their revenues, one fundamental we focus on is improving claims processing workflow to help ensure prompt payment. Prompt payment is about more than just having money in the bank - the longer a claim goes unpaid, the higher the chance that it won't get paid. At least, not without extra expenditure.


While collections are part of our services, it is always best to avoid getting into situations where extra effort is necessary to ensure payment. Following some best practices in claims workflow can go a long way towards minimizing such situations.


5 Critical Best Practices to Ensure Prompt Claims Payment

1. Daily charge posting

Your claims are going to have problems if improper charges are attached, and that becomes increasingly likely with infrequent or irregular charge posting. The minor extra expense of daily charge posting will be far outweighed by the problems it avoids.


2. Daily claims submissions

As with charge posting, claims submissions should be submitted promptly every day, whenever possible. Why introduce delays into your payments which are entirely preventable? Only submitting claims once a week is another practice which saves pennies, but frequently loses dollars.


3. Ensure you are using electronic submissions whenever possible

Go through your records of payers, looking for situations where you are still using paper methods even though they accept electronic submissions. At this point, there is no advantage at all to staying on paper - it's slower and more prone to error. If your office is already submitting 100% electronic claims, excellent.


4. Institute a claim editing engine

Modern claim processing software can go a long way towards streamlining your operation. A claim editing engine allows for faster editing of improper submissions and can usually be configured to incorporate other critical pieces of information. For example, having listings of filing deadlines for all your payers, so that any claims nearing the deadline get flagged. That said...


5. Investigate the root causes of claim edits

With very few exceptions, if a claim edit is needed, that means there was a mistake earlier in the process. Don't let these go uninvestigated! Drilling into the root causes of claim edits will usually reveal other unoptimized areas in your workflow. Addressing these issues will reduce your claim edits overall.


ProMD is here to help.


For more information on streamlining your claims processing workflow, just contact us.