Leveraging technology to help expedite reimbursements and enhance cash flow
Whitepaper | Eric Arnson
Senior Vice President of Product Management Change Healthcare
Eric Arnson has more than 20 years of experience leading complex growth initiatives in healthcare IT, manufacturing and retail markets. Arnson has a bachelor's degree from the Kelley School of Business at Indiana University.
Healthcare is a three trillion dollar industry that currently accounts for about 17.5 percent of the nation’s gross domestic product (GDP).1 By 2040, this figure is expected to swell to as much as 34 percent due to an aging population, rising healthcare costs, and other factors.2
As evolving market trends shape healthcare reimbursement, providers continue to be faced with real-world, day-to-day challenges that contribute to unpaid claims, unnecessary denials, workflow inefficiencies, and rework efforts.
By implementing a few key recommendations outlined in this article, providers can obtain the necessary visibility and control over their claims reimbursement processes that help to not only sustain a healthy revenue cycle, but also enhance the patient’s overall experience.
Get Ahead of Denials
Claim denials cause delays in payment and often result in unnecessary write-offs for providers. They can require a significant amount of time and rework, which costs providers an average of $25 per claim.3 According to the Centers for Medicare & Medicaid Services (CMS), as many as 30 percent of claims are denied on first submission, and a top reason for these denials is incorrect or missing eligibility information.4 Ensuring that all patients are screened for eligibility prior to service is the single biggest and most important step a provider can take to avoid costly denials down the road.
For many providers, coding issues also contribute to denials. All payers have their own nuances that coders need to understand.
The average cost to rework a denied claim is $25; for larger health systems with thousands of patient visits per year, the cost can reach well into the millions.3