Reduce Chaos in Your PFS Universe – Avoid Claim Processing Roadblocks

August 24, 2017 By: Quadax

The right claims management system can deliver the control you seek.

In Patient Financial Services (PFS) offices across the country, words like swamped, frustrated, and stressed can be heard as frequently as patient, billing, and coffee. The work is never-ending, with the rules ever-changing. In this world of chaos, when so many of your daily challenges are outside of your control, a claims management solution can help you avoid roadblocks, bringing order and peace of mind. 

Organize the work.

Your first line of defense against the chaos: organization. The principles of masterful organization are identify, classify, categorize, prioritize, and mobilize. To effectively deploy these strategies in your claims management system, start with workflow rules, statuses, queues, and views.

Workflow rules

Workflow rules put work where it needs to be, not where it doesn’t. Organized workflow rules identify and classify, routing the right work to the right people so those responsible can complete it. Only the persons responsible for completing it see it; others are not distracted by it, and the work is done once. Multiple touches impede efficiency, increase cost, and can cause confusion.

Workflow statuses

Workflow rules also drive the status of claims, labeling them appropriately according to the intervention required so that work is grouped efficiently and will not fall through the cracks. Review the statuses in your claims management system periodically, as well as the conventions for their assignment, to ensure that the statuses correspond to logical classification – enough to provide clarity and direction, not so many that they are perplexing.

Work queues or views

When the queues or views within your claims management system are organized, not only will the right work get to the right people, but it will be prioritized according to best practice for your organization. The easier it is to see what needs to be done, the easier it is to get it done.

Automate, automate, automate!

Automation is one of the best ways to ensure the cash flow is steady and dollars are not diverted from your mission. According to the 2016 CAQH Index, manual claims management processes cost providers $4 more than electronic transactions. So not only is manual work more costly, but these tedious and time-consuming tasks take your staff away from other work.

Examine the manual interventions currently required of your staff, particularly those that are highly repetitive. Configure rules within your claims management system to automatically process these tasks. Using automation you can optimize workflows and increase staff productivity.

Share knowledge and best practices.

Share knowledge and best practices with your staff. Provide an easily accessible resource that contains error details and other EDI-related information, explains payer requirements, and identifies best practices. If the answers to most questions and concerns can be found at your employees’ fingertips, costly mistakes can be avoided. Not only will your staff be more knowledgeable, but you and your team will gain control over your claim processing protocols.

Avoid claim processing roadblocks.

Are your claims traveling the best path for payment? Review your claims processing roadmap. Where in your claims’ journey is your staff experiencing roadblocks, pile ups, and bottlenecks? To help in your review, download Quadax’s claim processing infographic. 

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