3 Reasons Why Collections and Payment Posting Is Your First Defense Against Claim Denials

Hospitals and healthcare organizations are fighting relentless economic pressure in a turbulent healthcare landscape marred by wage inflation, rising costs, and the uncertain aftermath of a pandemic. And this situation is only made more severe by claims denials - an insidious drain costing hospitals an average annual loss of $5 million.

This financial bleed is becoming an epidemic, with denial rates surging by over 20% in the last half-decade and the average claim denial rate touching a worrying 10%. 2021 alone witnessed an alarming 17% spike in denials, according to a Medical Group Management Association (MGMA) Stat poll.

It's not just the volume but the cost of these denials that exacerbates the strain on healthcare Revenue Cycle Management (RCM) – reworking or appealing denials levies an average charge of $25 per claim for practices and a mammoth $181 for hospitals. The accumulation of these factors is a perfect storm, eroding the bottom line of our healthcare institutions and demanding an urgent remedy.

Luckily, that urgent remedy is already here - claims automation with Collector.

Why Collections and Payment Posting Should Be Your First Line of Defense

In a landscape where claim denial handling is a frontline battle for healthcare organizations, Collections and Payment Posting is an indispensable armor, swiftly identifying, updating, and resubmitting claims while reducing associated workloads. Here are the top three reasons Collections and Payment Posting promises to reduce claims denials and supercharge your RCM.

Denial Handling

Collections and Payment Posting swiftly pinpoints denials and their causes, fetching the requisite documentation from your EHR or PM system to update and resubmit the claim. When human intervention like phone calls or signatures becomes necessary, the system immediately alerts the relevant manager, guaranteeing same-day claim resubmission. This smooth, automated process dramatically lightens the denial handling workload.

For example, consider a claim denied due to a missing physician signature, a standard error. Collections and Payment Posting would instantly identify this error, pull the unsigned document from your EHR, and alert the responsible physician. After receiving the required signature, it promptly resubmits the claim—all within the same day, minimizing hassle and reducing delays.

Patient Responsibility

Collections and Payment Posting takes care of the cumbersome tasks, allowing you to focus on getting paid. Here's how it works: After applying the direct payment to the claim in your EHR, it determines the patient's financial obligation and outstanding balance. It then pulls the primary Explanation of Benefits (EOB) from the payer portal, adding a cover sheet if required. For instance, if a patient owes $200 after insurance adjustments, Collections and Payment Posting sends an invoice directly to the patient, monitors payment, and updates the claim status. It follows up as necessary, ensuring punctual collections and unburdening your team.

Payment Posting

Collections and Payment Posting seamlessly handles payment posting, eliminating errors, reducing workload, and ensuring maximum accuracy and efficiency. To illustrate, let's imagine a payment of $500 comes in from a payor. Instead of relying on manual input, the collector seamlessly logs into the necessary payor portals and retrieves the remit data and corresponding Explanation of Benefits (EOB). With this data, it directly posts the $500 payment in your Electronic Health Record (EHR) system, guaranteeing error-free application.

This automated procedure leads to a marked improvement in reconciliation accuracy. It also significantly reduces the likelihood of preventable errors - such as posting to the wrong patient account or incorrect charge adjustments - that often sneak in with manual handling

Final Thoughts

The numbers speak for themselves. Collections and Payment Posting has demonstrated a significant impact in optimizing revenue management for healthcare organizations. With a substantial 235% increase in ROI attributable to collections and an expedited average revenue cycle collection falling under 30 days, its value is hard to overlook. Moreover, the 95% reduction in the manual effort required for payment posting demonstrates the system's potential to streamline operations and increase efficiency. Therefore, Collections and Payment Posting represents a transformative tool in the modern healthcare Revenue Cycle Management landscape.

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Published On:

December 6, 2024

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