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POSTS BY TAG | patient experience



Claim denied. Ugh! These are two words that make all those involved in the health care revenue cycle cringe. Unfortunately, claim denials are very common, costly, and time-consuming to correct. However, there are strategies to avoid them, with the potential to significantly increase your bottom line and decrease your revenue-related headaches. We’re going to talk about one of those strategies here — real-time eligibility. 

Why Are My Claims Being Denied?


Eligibility verification is one of the first phases in the revenue cycle and by far the most significant. Did you know eligibility issues are one of the top five reasons claims deny? In fact,  nearly 24% of claims submitted are denied for eligibility and registration issues, such as the patient not being eligible for medical benefits on the date of service, or having incorrect demographic information, like date of birth or a misspelled name. 

The eligibility verification process is directly linked to claim denials which can have a variety of unwanted consequences. This includes a hike in the number of days in A/R, an escalation in write-off rates, a standstill of cash flow, inflated costs to collect, and most importantly, delays in a patients' access to treatment. The process of verifying eligibility needs to be both efficient and accurate in order to determine the responsibilities of both the payer and the patient.

How Do I Make Sure My Claims Aren’t Denied?


Most claim denials are avoidable, in fact, 90% of them could be avoided. Research also shows that of those denied claims, approximately 60% of claims are recoverable, meaning they can be corrected and resubmitted for reimbursement. 

This sounds pretty good, right? Well, the reality is that a whopping 65% of denied claims are never reworked, which translates to a huge loss in revenue. The remaining claims that are reworked can be a drain on resources when factoring in both time and overhead costs. The average cost to correct and resubmit a denied claim can range anywhere from $30 - $125 per claim.

By implementing the right tools and processes, such as checking real-time eligibility, the likelihood of having your claims denied decreases significantly. By simply using real-time eligibility tools, you’ll be able to increase the number of  “clean” or error-free claims submitted,  tackling a number of the top reasons claims are denied, such as eligibility, no authorization, or being covered by another insurance plan.

What Is Real-Time Eligibility?


But what exactly is real-time eligibility, and how do I use it to my advantage?

Real-time eligibility is a software tool that allows medical staff to electronically confirm a patient’s insurance coverage by interfacing directly with the insurance carriers. This instant eligibility check provides an up-to-date overview of the patient’s coverage and plan benefits. Real-time eligibility can answer important questions such as if the insurance policy is active, the start and end dates of a policy, deductible amounts, copay coverage, and if prior authorization is required. Verification checks can be done at the time of the patient’s appointment, or even prior, which not only saves both the staff and patient time during check-in but also provides a clear understanding of both the provider and patients’ responsibilities.

Real-time eligibility benefits all those involved in the revenue cycle management process. For example, the amount of time staff spends checking and verifying a patient’s coverage is reduced significantly, as it eliminates back and forth phone calls, and the need to check multiple systems in order to verify coverage. Additionally, verifications are saved to the patient’s record, which provides an audit trail and proof of insurance coverage. Plus, it makes it much easier to submit clean, error-free claims, which facilitates faster payment and improves cash flow, which leads to increased provider satisfaction. Let’s not forget about the most important part of the revenue cycle, the patient. Being able to communicate to the patient their financial responsibility prior to, or at the time of service, makes for a much-improved patient experience.

Claim denials are preventable when identified and addressed early in the revenue cycle process. By implementing real-time eligibility, you can decrease the burden of claim denials, and in turn, enhance revenue, improve the overall patient experience, and let the provider focus on what matters most — patient care.

Learn About pMD Medical Billing & RCM Tools & Services


If you are interested in learning more about pMD’s billing and revenue cycle management services, please contact us here or give us a call at 800-587-4989 x2. We’d love to hear from you!

 

To find out more about pMD's suite of products, which includes our charge capture and MIPS registry, billing services, telehealthsecure messagingclinical communication, and care navigation software and services, please contact pMD.

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Improved medical billing and payment system boosts patient satisfaction

Everyone who has received medical care in the U.S. has experienced the complex system built around paying for the care you receive. From complicated insurance types to delayed and unforeseen bills, many agree that the financial burdens that come from U.S. health care are the toughest to swallow. The system, in all its complexity, is difficult for a reason. The negotiations that take place between insurance carriers and medical billing teams determine the amount that each patient has to pay on a case-by-case basis. The limited forms of payment exist for the security of the patient and the protection of their private health information. But is there a way to improve the patient experience when it comes to paying for medical care?

Providing Patients Cost Estimates & Easy Way to Pay for Medical Care

In 2018, in a survey conducted by HIMSS Analytics, researchers found that 68% of patients would be more likely to return to a practice for future care if a cost estimate was available to them at the time of service. It was also found that 75% of patients wished they could keep a credit card on file for any balances that come up during their care. Simple fixes go a long way towards improving patient retention and driving practice growth. The easier you make it for your patients to pay for their care, the more money you are likely to receive.

Benefits of Providing Patient Care Cost Estimates

Cost estimates of patient care are one of the largest things a practice can do to make patients feel more financially comfortable while navigating their episode of care. An unforeseen bill, or one that is larger than expected, can unsettle a patient and may lead to higher rates of uncollected revenue. Upfront estimates provide peace of mind and allow patients to make informed decisions about the care they are receiving. The HIMSS Analytics survey found that 46% of patients also said they would be more likely to pay a significant portion of their bill upfront if an estimate were available. This simple step can create massive benefits for both practice and patient by keeping all parties informed and engaged throughout all aspects of care.

Patients Prefer Modern Medical Billing & Payment Solutions

The growth of consumer culture in health care also means patients want to be able to pay for their visits using modern solutions. Scheduling apps and HIPAA-compliant payment portals are growing in popularity and patients are responding positively. By allowing patients to pay online, not only is the patient experience improved, but the providers will receive reimbursement for their work faster than paper billing alternatives. A 2016 survey by Aite Group shows that 56% of all bills that year were paid online, while 77% of health care practices specifically use paper billing systems. This comparison shows that the needs of the 50% of patients that state they would prefer online or paperless medical billing are not being properly addressed by their health care providers.

pMD Charge Capture the First Step

Tools like pMD® Charge Capture™ allow providers to capture their charges in real-time and reduce billing lag. These workflow improvements are the first step to providing patients with quick and accurate estimates of the money they owe and create more actionable opportunities for providers to maximize their revenue while driving patient growth. It all stems from the patient experience.

Related Articles:
What to Look For When Evaluating Charge Capture: Charge Lag Statistics
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To find out more about pMD's suite of products, which includes our charge capture and MIPS registrysecure messagingclinical communication, and care navigation software and services, please contact pMD.


 

Telehealth, or telemedicine, has existed for years, but with the emergence of COVID-19, the relationship between telehealth and the health care industry was transformed practically overnight. For most practices, COVID-19 catapulted telehealth from a long-term possibility to a complete and immediate necessity. According to AARP, demand for telehealth surged 1,000% by mid-April when compared to the time period before the emergence of the COVID-19 disease. This change came with a need for providers to train staff, evaluate software vendors, and devise new workflows to support telehealth. The patient side of the health care industry was equally disrupted, with individuals no longer able to continue their care in person. While some patients had experience with video conferencing through their employers or through FaceTiming family and friends, many were thrown into a new world of installing software, attaching webcams, creating accounts, and setting passwords.

Supporting patient adoption


At pMD, we have always been dedicated to easing the burden of learning or implementing new technology for both practices and patients. We have decades of experience working closely with practices to customize our software to meet their needs. The pMD team trains practice staff, provides 24/7 technical support, and implements our software in a way that best fits each practice’s existing workflow. The same approach is taken with patients using our software. We give them direct access to our knowledgeable employees who can help them work through even the hardest technical issues, we train them to use the software when needed, and we allow them to accomplish their telehealth encounter using the device and process that makes the most sense for them.

While pMD approaches helping practices and patients in a similar way, patients' needs differ in many ways. Individuals have a wide range of experience and comfort with technology. They use different software and hardware from many practices, sometimes using phones or computers that can be up to 15 years old, and they may be running software equally as out-of-date. If an individual encounters issues with software compatibility, they don’t have an IT department to contact in the same way many practices do. At pMD, we do our best to support every possible software and hardware configuration on laptops, desktops, phones, and tablets. We also integrate all options in a seamless manner, allowing for use of a web browser or a native app. 

The seamless patient experience


On the software engineering end, this involves addressing a complicated mix of all possible configurations with special attention paid to potential issues and workarounds. But, on the patient’s end, it simply looks like a functioning telehealth encounter that is as easy to use as clicking or tapping on a link or on a push-notification. The goal is to have the patient able to interact with telehealth in a manner that fits smoothly into their daily life. Patients can move easily from texting their children one moment to tapping on the text-message link telehealth visit the next. Users can pause their twitter use to tap a push-notification alerting them that their telehealth appointment is about to begin. Or, they can switch from emailing colleagues to starting their telehealth encounter by following a link sent to their inbox. And it all just works!  Nonetheless, if there are questions, as always, a friendly pMD employee is always ready and waiting to help with any issues that may arise. Want to learn more about pMD telehealth? Contact us! We'd love to hear from you.

To find out more about pMD's suite of products, which includes our charge capture and MIPS registrysecure messagingclinical communication, and care navigation software and services, please contact pMD.