Aged claims may make up a small fraction of your hospital’s overall income, but they still matter. You don’t want those claims to sit in your debt bucket, unpaid, especially when they mean the difference between operating on thin financial margins and having a cushion in place. Understanding the revenue cycle is a big part of this. Of course, while those aged commercial health insurance claims may end up going through the three state-level appeals and the Federal ERISA appeals process before they’re paid up, the efforts that you make at the beginning of the revenue cycle matter. Here’s what you need to know.
Approaching Denials Properly
According to the experts, “We’re approaching denials in a multidisciplinary way. We don’t work our denials ourselves. We use agencies. They have staff here working alongside with us, [and] we have committees by facility. And we review denied account examples and try to get everybody’s input to identify patterns and try to put processes in place to at least resolve what we’re identifying at the time. What we find is once we fix something, we start seeing denials in a different category. It’s the never-ending story because regardless of what we fix, something new comes up. We are currently working on developing ANNOVA [a tech solution] to assist us in predicting and preventing denials.”
It’s Important to Plan Accordingly
Those same experts go on to say, “You need to dig into your data to understand your current status. To set an action plan for the future, you need to understand exactly where you are and know where you want to go. I think sometimes people make decisions because they go by a hunch, but they cannot validate it with numbers. We don’t put any processes in place unless we have validated that, in fact, there is a need for improvement. We use an internal database, RC-AIM, to assist us with analysis.
Leadership Is Also Important
There’s a bit more to it than just data, “Lastly, invest in the leaders. The revenue cycle area is becoming smaller. Twenty years ago, every hospital had a business office. Today it’s either centralized or outsourced. Every time you have to replace a leader it becomes challenging. Invest in the individuals you have today to develop the leaders of the future and encourage them to develop their staff so they can also grow with the organization.”
Clear Up Your Aged Claims
Want to clear up your aged claims? Contact us today. We’re the experts in filing Federal ERISA appeals and can get those aged claims paid for you. Yes, the commercial health insurance companies do indeed need to pay you for those claims. We know how to handle them. Call us today or fill out our contact form to get started. One of our experts will reach out to you soon. It’s never too late to clear up those aged claims that have gone past their three state-level appeals. When it comes to running your hospital or clinic, every penny counts.