Is Your Healthcare Revenue Cycle Haunted?

October 31, 2017 By: Quadax


Thrills and chills may be fun at Halloween, but not when staff is trying to process claims. Things that go bump in the night can be causing payment delays! Exorcise the ghosts in your revenue cycle—review these ghost busting tips and get the most from your RCM claim processing and clearinghouse solution.

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Intelligent automation throughout your claims process can help accelerate your revenue cycle. Are you experiencing ghastly gaps in your automation?  What can you do about it?

Frequent interruptions caused by your upload routines can make staff fear the start of a new day. If daily interfaces are failing, you may want to implement custom interface logic and monitoring tools. This can improve claim data integrity while safeguarding staff productivity.

When front-end payer rejections prevent your claims from reaching payer adjudication, it may be time to consider a new clearinghouse. If your claims first pass rate is less than 99.6%, then your RCM is being impeded by an under-performing editing engine. Your claims processing engine needs access to the must current industry rules for cleaner claims and faster reimbursement.

You cannot afford to still be processing paper when electronic options are available. If you are still sending hardcopy claims, engage your clearinghouse’s electronic payer connections to send more claims electronically. Electronic processing can expedite payment by cutting claim processing lead time by more than half.

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With the right RCM tools and resources, staff can enhance productivity and optimize claim processing. Are frightful system inefficiencies terrorizing your staff? Identify where and when and ways to solve them.

Repetitive manual processing delays all good men and women from achieving their best. Do not allow your staff to be held hostage by the RCM vendor who only allows for custom programming. Enable your staff with high-performance tools and resources. Your RCM solution should allow your staff access to self-help options for engaging your system’s automation. We recommend easy-to-use wizards where staff operators can create auto-correct rules and custom claim edits specific to your business needs. 

Paper worklists limit management’s ability to optimize your billing operation and balance workloads. Make sure priority claims are worked first. Organize your labor force using configurable electronic worklists, integrated reports and dashboards, to prioritize work for maximum effectiveness. 

Clumsy communications among claim processing teams can put your organization at risk for security issues and inappropriate disclosures. Stop staff from using emails and shared spreadsheets. Expect your software to provide for cross-functional, interdepartmental workflow and communication, especially when a claim requires special handling. It should also provide for automated comment records to keep staff and systems in-step and in-sync. 

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One of the most deadly claim processing errors is missing a payer filing date. Is your RCM system allowing you to miss filing deadlines? 

Do not let your revenue be defeated by the walking dead; make sure your claims never miss a deadline. At-a-glance dashboards and warning flags can help you monitor age of claims and days in A/R so that filing dates are managed and met. 

Footer2.pngIf there is something strange in your RCM neighborhood, something’s weird and it doesn’t look good, who can you call? Quadax Xpeditor™ can free your RCM of haunted processing.



Make sure your claims reach payer adjudication. When selecting a clearinghouse, compare first pass rate—percentage of claims accepted for adjudication on initial submission. A difference of one percent can represent thousands of claims. Learn more about Quadax’s industry-leading 99.6% first pass rate.



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