Driving Efficiencies in Your Claim Management Cycle

Arun Joseph VargheseArun Joseph Varghese on August 5, 2021

Claim management can be complicated. It is a critical component in the healthcare system. There are a lot of processes that need to work in line with one another, and they’re all working under tight deadlines. If any of these pieces go missing or get stuck somewhere along the way, it can lead to delayed payments, denied claims, inaccurate data reporting, and more – not to mention the stress for everyone involved. It doesn't have to be this way!

In this blog post, we'll discuss how you can drive efficiencies in your hospital claim management cycle through different means with the help of hospital management software.

Medical coder review

With the help of billing software, the hospital can ensure that the billing procedures are completed error-free. But when it comes to insurance claiming this alone is not enough. It is very much required that all the necessary data, from the name of the patient to the insurance details and all the billing details, have been coded accurately to avoid rejections.

The Medical coder review features of hospital management software help to ensure accurate communication and coordination with the doctor, reducing the turnover time for back and forth clarifications enabling higher quality claim scrubbing and submissions. This is quickly possible as all the required data are achieved by the hospital management software through its seamless integration with all the departments and third-party equipment used.

Ensuring quality of coordination and transparency of data

To ensure the efficiency of your hospital claim cycle, it is inevitable to cooperate with different sectors. For example billers, medical coders, finance, and accounts all have to work together for error-free insurance submission and cooperate when there is a resubmission required.

The hospital management software can integrate clinical billing software, medical coders, insurance, or claim submission software for clinics which creates a single point of access to enhance transparency and increase coordination with cooperation.

Ease of managing claim submissions

The easier the processes are the better the results will be. To decrease the rate of rejection and to increase the efficiency of claim submissions, hospital management software offers simple processes compared to the hectic manual submissions which are prone to mistakes. 

The complexities in each stage of data collection and submission are further reduced with the help of a hospital management software system that can integrate with insurance aggregators which ensures that data is not lost in transmission. 

Capture audit trails to track changes

Another feature that can improve the efficiency of your claim management cycle is audit trails which help to track accounting, patient details, or other financial data to its source. This will help your hospital be better prepared for the insurance audits which in turn will help to attain claims.

Hospital management software with its revenue cycle management features helps to extract audit trails accurately and presents them as user-friendly reports to have a better view of the steps followed during the coding process. This helps to track any changes and monitor updates with ease.

Tracking of metric

Studying and understanding past mistakes and errors is an excellent way to improve future results. Using hospital management software to track metrics throws insights into the number of claims submissions, the number of resubmissions, the claim rejection rates, and the cost per claim.

This collective analysis helps to identify and point out the exact reason so that it is easier to forecast how to prevent them in the future.

Adherence to changing regulatory standards

The change in health insurance regulatory standards affects every part of the claim management cycle. It is very important to adhere to these standards for claim approval and insurance reimbursement. The category to which each claim is assigned has to fulfill the definitions assigned by the regulatory authority any minute changes in which will result in a claim rejection. 

There are several aspects like this that need to be scrutinized to avoid rejections and resubmissions. Hence the most important factor that the hospital has to ensure for efficient claim management is adhering to regulatory standards and to be up to date with the changes they make.

Insta HMS offers claim form documentation, Medical coding, and claims scrubbing by the encounter, E&M, ICD, CPT, LOINC, Dental, Drug, HCPCS, DRG, Per Diem codes with adherence to Waseel/DHS/DHA/HAAD standards, integration with Waseel/DHS/Shafafiya and eClaimLink platforms for claim submissions and much more to help you drive efficiencies in your claim management cycle.

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August 5, 2021


August 5, 2021