The experiences of the Hand & Wrist Center of Houston—a surgical practice that treats hand, wrist, forearm, and elbow conditions—exemplify how, by providing support in the following ways before and after the delivery of healthcare services, technology and services can help organizations avoid denials.
Determining eligibility and obtaining pre-authorizations or verifications more efficiently. Recognizing that denials often result from failing to determine eligibility or to obtain pre-authorizations, the Hand & Wrist Center of Houston uses an integrated revenue cycle management solution to determine eligibility on the front-end of a patient interaction, as well as to quickly obtain pre-authorizations and verify benefits. As a result, the center was able to eliminate all denials related to pre-authorizations.
Navigating coding nuances. To help navigate coding nuances and ensure payer requirements would be met, the Hand & Wrist Center of Houston sought a vendor with broad payer coverage, recognizing that industry experience was of paramount importance for understand billing nuances. The center also uses an electronic health record (EHR) and practice management system integrated with a claims clearinghouse to automate and streamline coding. Since implementing the technology, the center has eliminated most coding pain points and significantly reduced coding-related denials without staffing in-house coders.
Auditing and scrubbing claims before submitting. Claims should be as accurate as possible to save costs while maximizing potential to collect. The Hand & Wrist Center of Houston uses its revenue cycle management technology to automate the claims auditing and scrubbing process and flag any claims requiring action prior to submittal.
Minimizing rework to optimize time and resources. “Work by exception” and “embrace process automation” should be providers’ mantras when looking for tools to streamline the revenue cycle. These maxims informed the Hand & Wrist Center of Houston’s efforts to avoid excessive reworking of denial claims caused by denials and the high cumulative cost of such rework. The center was able to achieve its objectives through a focus on improved workflow efficiency and automation, aimed at enabling staff to focus their time on more complex cases.
Ensuring filing deadlines are met. Using technology to identify aging claims or appeals, healthcare providers can implement “crosschecks” to ensure filing deadlines are not exceeded. Hand & Wrist Center of Houston’s uses 40/80 crosschecks—that is, looking back at the claims status regarding charges for all services delivered 40 and 80 days previously. Each claim is reviewed to ensure there is time to correct any issues prior to any aging deadlines.
Improving visibility. To oversee an entire claims process efficiently, organizations should have complete and comprehensive visibility over their billing operations. Hand & Wrist Center of Houston therefore uses tools that offer a full-service revenue cycle solution that provides a single view of the entire process.
See related article: Practical Tips for Maintaining Control over the Revenue Cycle
The author would like to acknowledge the contributions of Sean Lundy, CMPE, administrator of Hand & Wrist Center of Houston, in developing this article.