Revenue cycle management (RCM) is continuously evolving. Longstanding challenges like manual AR reconciliation or limited options for prioritizing claim follow-up are finally being solved with the advent of innovative technology. In fact, according to recent research 62% of leading health systems now work with technology vendors to status claims.
While these solutions are transforming healthcare RCM, not all technology is created the same.
What should you be thinking about when it comes to maximizing your claim monitoring? In our recent webinar Work Smarter: The Next Evolution of Claim Statusing, Rebecca Pierce unveiled three Cs to better claim monitoring. Each covers a challenge created by the current status quo and a solution to work smarter while improving performance.
1. Curate the most enriched status responses
The status quo
Many organizations still rely on 276/277 EDI transactions with a heavy emphasis on manual payer follow up via online portals and phone calls to get claim status updates.
Key considerations
- How is your organization obtaining status updates?
- Are you maximizing various methods (e.g., x12, RPA, API, etc.) to capture the most comprehensive claim status responses?
How to work smarter
- Once you obtain those comprehensive responses, you can go beyond 277 and CARC codes and receive payer-specific details.
- Use purpose-built automation to normalize response data and derive key insights for additional control tools.
2. Control claim follow-up + proactively remediate issues
The status quo
The limitations of PM/HIS systems and vendors reduce organizations’ ability to determine and control when to run status checks, with uncertainty about which accounts or records to prioritize and no clear way to leverage status data to meet business objectives.
Key considerations
- How would you change your claim follow-up strategy if you had more clarity on remit timing?
- Does your claim status process provide response data in a format that lets you easily take follow-up actions?
How to work smarter
- Use predictive analytics in conjunction with expansive payer data to forecast remit timing and reduce the number of unproductive touchpoints while unlocking insight and clarity for your team.
- Integrate this data directly into your workflow to ensure the right team is working on the right claim, each as efficiently as possible.
3. Capture payments faster + forecast your accounts receivable
The status quo
Most organizations depend on reactive processes and often limited visibility into claim status, reducing their ability to capture payments. This lack of insight also results in difficulty identifying organizational patterns that could be adjusted to better support your team and optimize their tools and performance.
Key considerations
- What customizable tools or capabilities could allow you to better manage follow-up?
- What additional processes could be improved if you had better visibility into claim status, remit timing, and the overall health of your accounts receivable?
How to work smarter
- By leveraging payer data in an advanced way, you can gain both a better sense of remit timing and be more proactive on denial intervention.
- Customizable work groups let you evaluate potential denials and expected payments to assess the probability of appeal success and payment.
Wrapping it up: taking the smarter approach to claim monitoring
With margins under pressure and denials increasing, it’s more important than ever to use a proactive, intelligence-driven approach to claim monitoring. Working smarter means using purpose-built automation and predictive analytics to take waste out of your processes, get ahead of denials, and manage the health of your accounts receivable.
Want to learn how Claim Monitoring from Waystar can help your team work smarter and get reimbursed more quickly and accurately? Click here to learn more.
