Healthcare management has never been easy, but the end of the pandemic has brought about a seismic shift in the healthcare landscape, and medical practices feel the strain as they navigate the road to recovery.
As clinics and hospitals witness patients return in full force for routine care and elective procedures, medical practices face a perfect storm of challenges that risk their revenue management. The hurdles seem insurmountable, from staff shortages and rising costs to administrative burdens, slower payments, and an overwhelming physician workload.
Fortunately, technological advancements have fueled a profound transformation in the healthcare industry. Innovative software tools have paved the way for cleaner claims, improved efficiency, and a streamlined revenue cycle alleviating administrative burdens.
In this article, let's delve into the real struggles that medical practices face and explore how robust claim management can boost your practice's revenues and alleviate the stress on healthcare providers.
According to a recent survey by Experian Health, approximately 30% of healthcare leaders report a noticeable upward trend in claim denials, with an increase ranging between 10% and 15%.
When a claim is denied, your staff needs to allocate additional effort towards resubmitting the claim; this takes time, leading to a delay in reimbursement. Often, these appeals can stretch over several months before resolving, imposing a significant financial burden on healthcare facilities, amounting to thousands of dollars.
According to the recent Crowe RCA benchmarking analysis, the proportion of receivables aged over 90 days — a measure of AR performance — has risen from 32% in January 2021 to 37% in August 2022.
One of the primary causes of claim denials is the incorrect usage of codes and modifiers — a common error in manual workflows. However, providers can effectively address this challenge by adopting electronic claim submission workflows.
Electronic processes provide built-in checks and validations that help ensure accurate code and modifier usage, reducing the likelihood of denials. Additionally, automation expedites the claim submission process, ensuring timely submission of claims and preventing denials due to late submissions.
The 2021 annual report by the Council for Affordable Quality Healthcare (CAQH) highlights that the healthcare industry could save an impressive $20 billion annually by fully adopting electronic transactions.
Embracing electronic claim submission increases clean claims, improves revenue generation, and saves significant time. This allows physicians to be more productive and prioritize quality patient care.
The AMA reported that approximately 63% of physicians experienced at least one manifestation of burnout during the pandemic. As a result, several physicians decided to leave the profession, leading to a labor shortage in the healthcare industry.
According to a report by the Association of American Medical Colleges (AAMC), there is a projected shortage of 37,800 to 124,000 physicians by 2034, with a primary care physician shortage estimated to be between 17,800 and 48,000.
One of the primary causes of physician burnout is the excessive administrative tasks they have to handle. A recent Medscape report highlighted that physicians spend approximately 15.5 hours per week on paperwork and administration, significantly adding to their workload and stress levels.
But, the good news is electronic claim submission workflows can help lessen administrative burdens.
Every year, healthcare providers face fresh challenges as new CPT codes are introduced, and existing codes undergo changes. And this year is certainly no exception.
CPT® 2023 brings numerous code changes as expected, with 225 new codes, 93 revised codes, and 75 deleted codes. These changes impact every section of the CPT® 2023 code set, except anesthesia, requiring thorough understanding and adaptation to the updated coding guidelines.
Staying compliant with these regulations enables accurate reporting of medical procedures. However, manual claim processing poses a higher risk of errors.
Electronic claim submission workflow plays a vital role in this process, incorporating built-in validation rules and edits. These features help ensure the accuracy and completeness of the submitted claims, minimizing errors and enhancing the overall quality of the claims.
By leveraging electronic claim submission systems, healthcare providers can streamline their processes, optimize reimbursement accuracy, and effectively capture the diverse range of services provided, ultimately improving patient care and financial outcomes.
Glenwood's GlaceRCM offers healthcare providers a robust solution for accurate and comprehensive claim submission. Our proactive approach addresses claim denials and optimizes accounts receivable (A/R) management. We are dedicated to maximizing your financial success by capturing all billable services and ensuring every bill is meticulously followed up until it is collected. Partner with us to ensure your practice submits robust claims, leaving no room for overlooked services or bills.
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