Tip 1: Emphasize PAS Training
Patient access training “isn’t one-and-done.” It requires continuous attention and care. When trained properly, your front-end staff is better prepared to gather the right information and complete the right tasks to prevent payment issues upfront resulting in maximized reimbursement, increased timely account identification, and improved patient satisfaction.
Tip 4: Focus on Billing Efficiencies
Keep up to date on submission requirements. Reduce days to payment through clean claims submission and aggressive follow up, utilizing electronic submission whenever possible. Track the reasons why you have to resubmit or appeal a claim so that you know why your payments are delayed or denied.
Tip 6: Investigate Claims Thoroughly
Thoroughly investigate every claim according to the regulations of the specific state. Focus on coverages that pay without a determination of liability when it comes to motor vehicle accidents or third-party liability.
Tip 2: Consider Filing Liens
Liens can be good for the patient and provider. By filing a lien the patient’s account can be placed on hold until it is paid or a settlement occurs. It only attaches to the potential settlement, not the patient’s home or other assets. For the provider, a properly filed hospital lien can help ensure you receive the settlement proceeds that were allocated for your medical bills.
Tip 7: Identify Denial Root Cause
Denial prevention begins with identifying the root cause of the denial — asking “why” and then “why” again. Key areas to consider include access to documentation; timing of inpatient orders; physician rationale; peer-to-peer review; clinical guidelines utilized; documentation quality; and communication/process issues.
Tip 3: Ensure Medical Necessity
Make sure your staff has a thorough understanding of the fine print of payer contract language. This includes clinical documentation requirements, clinical scenario limitations, documented evidence of more conservative therapies, as well as frequency limitations.
Tip 5: Enhance Process Improvement
Just as hospitals have staff turnover, so do payers. Look for opportunities to strengthen information sharing and process improvement. Examples include providing payer feedback when incorrect criteria were used to deny the claim; sharing documentation opportunities with physicians; and capturing accounts for which UM review is not completed.
Tip 8: Write Effective Appeals
Carefully craft appeal messaging by engaging in the art of persuasion. To present arguments with the biggest impact use the IRAC (Issue, Rule, Application, and Conclusion) writing method. This method structure enables an argument to be presented in the fewest words with the most impact to change the opinion of the payer.