As the transition to value-based care continues and healthcare providers experience an increase in claims denials, many are looking for new solutions for handling value-based care and fee-for-service claims.

According to a recent HIMSS Analytics survey, roughly one-third of health care providers are still using a manual process to manage claim denials.

“Given the complexities around submitting claims and the labor associated with managing denials, it came as a surprise that more organizations have not automated the denial management process through a vendor-provided solution,” said Brendan FitzGerald, HIMSS Analytics Director of Research. 

“The move to value-based care and alternative payment models will not happen overnight.  Until those models are tested and implemented, healthcare organizations will continue to focus on current processes, and automating the denial management process could greatly enhance collection efforts.”

The Benefits of Automating the Claims Process

Those providers who want to stay profitable and meet future challenges should consider making the move to automation, which offers numerous benefits. For starters, automating the claims denial process means eliminating time-consuming paper-based processes. This not only decreases time spent on tasks but also improves the accuracy of information, streamlines maintenance and retrieval of data, and increases productivity while cutting costs.

Here are some other advantages of using an automated claims system:

• The time saved can be spent with patients, ensuring the best care possible is delivered
• The software automatically conducts a pre-audit to find any errors before the claim is submitted to a payer. Less errors mean less claims denials
• Claims can be submitted almost instantaneously to payers
• Reduction of postage, supplies and mailing expenses
• Providers can easily track a claim’s progress between intermediaries and a payer through an audit trail
• Get confirmation that a payer received the claim through reporting features
• Expedite the entire process and turnaround, and thus payment timeframe
• Increase the practice’s accounts receivable

Automation – The Antidote for ICD-10 Challenges?

You’re no doubt well aware that the ICD-10 transition grace period is coming to a fast close. Beginning October 1st of this year, CMS and its contractors will require the correct diagnostic codes to be submitted in order for providers to be reimbursed.

What does this mean exactly? It means providers will no longer be able to use codes like “Unspecified,” “NOS,” or “not otherwise specified.” Doing so will cause particular scrutiny from CMS, will slow payment processes down and potentially lead to loss of revenue. There are two options here:

• Physicians and billers can assume they memorized all of the correct codes, submit them and hope for the best, or…
• Automate their billing processes and leverage technology to find any errors before submitting.

Choosing the Right Automated Billing Software

Practices looking into medical billing software should take a number of considerations into account. While it is possible to have your billing and EHR solutions come from two separate vendors, provided the solutions can be interfaced and play nicely with each other, it’s often easier to purchase the two technologies from the same company.

Another issue to take into consideration is the number of support vendors provide both during and after the implementation. Does the company charge fees for system upgrades, service calls, and hosting? If so, all of those extra costs can add up quickly and become a bill a practice simply cannot afford. It’s important to know all the costs upfront so you can determine if the solution is affordable or not.

And perhaps the biggest consideration is, how capable is the technology of supporting practice goals in terms of ongoing healthcare reform and internal growth? Can the solution handle ICD-10 and 11, 12, down the road? Can it handle meaningful use requirements and participate in the new value-based payment model? In order to be worth the investment, the billing/EHR system must be capable of helping the practice manage patient populations and keep pace with industry changes.

Are You Ready to Automate?

CureMD orthopedics medical billing Service is an end-to-end revenue cycle management solution geared towards more than 32 specialties. Our award-winning billing and EHR software will get you reimbursed more and faster.

Regardless of the size or location of your practice, CureMD makes transitioning a simple, cost-effective, and painless experience. We handle all system setup, documentation, EDI implementation, process coordination, and training at no additional cost. There are no software installation fees or upfront setup costs. You only pay us for the dollars we collect.

If you’re tired of claims hassles and ready to automate, get in touch with us today.