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Bobbi Lilly-Trakas

Key Ways to Improve Claims Management and Reimbursement

August 1, 2018

Biller, PM, RCM 3 Minute Read

It’s news to no one that healthcare is changing–– and fast. Organizations are re-evaluating aspects of their model at nearly every level, leading to dramatic shifts, such as the growing move from per-service fees and toward performance-based payment. Value is overshadowing volume and providers are more often centering their care around patients, ultimately taking on more risk and disrupting the revenue cycle for good. While the healthcare industry is in flux, revenue, claims, and reimbursement simply has to be managed differently. Here are some essential ways to improving this management process.

Start With A Clear Picture

A manager in the dark cannot effectively do their job. This is particularly evident in the revenue cycle, where hidden inefficiencies in one department can lead to an exponential negative impact on the bottom line as other departments suffer interruptions, confusion, and more. Making improvements to the reimbursement process and eventually the bottom line begins with gaining a clear and accurate perspective. To develop a complete understanding, there are three main areas that are worth devoting your time to: finance, technical, and operations. Finance gathers data about accounts receivable and the management of denial rates. Technical evaluates the actual processes and systems that go into providing care. Finally, operations involves staff, vendors, and workflow management.[1] Investigating an organization can last weeks and even months, but the thoroughness is well rewarded. Step-by-step improvements can be helpful, but a complete, holistic shift at every stage of the process magnifies the effectiveness.


Finding a Place in the Revenue Cycle

Reimbursement management hinges on examining the revenue cycle and understanding how each part of a provider’s process fits in. The ultimate goal is consistency and predictability in reimbursements, allowing for effective adjustments and accurate analysis. Leaders from each corner of an organization not only need to understand their role, but also the role of each department, creating a more focused, direct communication. Regular meetings keep key players in the loop and allow for other departments to find outliers that might otherwise fall through the cracks.

Implementing the Necessary Changes

Making holistic changes is no easy task and success depends on having the right tools. Billing and Revenue Cycle Management services from ChartLogic offer these valuable tools in a complete package, easing the formidable challenge of improving the bottom line. ChartLogic services removes the need to devote time and energy to understanding and managing billing, allowing providers to focus on what matters: patients. This freedom will become even more valuable in coming years as patients want to know what they’re paying for. Weighed-down providers managing the financials will get left behind by more patient-focused organizations. ChartLogic’s years of expertise and industry-leading technology allow a medical office to improve their reimbursement and claims management while spending less time managing it. With the right partners, an industry in flux doesn’t have to mean an industry in jeopardy.

For more information on how to make the switch from in-house billing to a Revenue Cycle Management Service, click here.


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