Every medical business office knows that it takes time and energy to complete the claims collection process. You have to login to each portal, or call every insurance in order to get an update on your claims. Then, you have to record all of the updates so that during your next meeting with the rest of the business office you are able to present the status of the accounts receivable (AR).
If you are like most medical billers, your responsibilities include:
Enriching
- Solving resident or resident’s family problems
- Ensuring the care and safety of your residents
- Ensuring the financial health of your skilled nursing facility
Mundane
- Entering Charges
- Posting Payments
- Submitting claims
- Claim Status Follow-Ups
- Corrections/Denial Management
- Monthly finance meetings
- Month End Close
As such, it is likely that you must schedule your follow-ups around these other responsibilities. In addition, if you are like most billers then your primary focus is addressing the resident’s concerns. This means that you push your follow-ups until you have posted the remits or before the next month end close.
Now, let us say you have planned to follow-up on the claims for next Tuesday. You wake up, head into the office, pour yourself a cup of black coffee, sit down at your desk, download aging report, pull up your notes and begin to plan your follow-ups.
You decide that you will be checking your Medicare claims first. Just as you are about to log in to the portal your MDS coordinator walks in and needs your help. For the next thirty minutes, you attend to their needs.
You get back to your desk, and your coffee is cold. You have to go heat it up. You sit back down and log in to the Medicare portal. You enter in the first member number and dates of service. You locate the claim and start to record the status. The phone rings – it is a resident’s family and they need your help with understanding their statement. For the next sixty minutes, you review their questions and relieve their concerns.
Again, you sit back down and because of the inactivity, you need to log back into the Medicare portal. In addition, your meeting with the therapy department starts in the next thirty minutes. You know that you need to get your notes updated but you do not have enough time to login, check each claim, record the statuses before the meeting begins. Now you are in business office limbo.
You have your meeting and decide to resume your updates. You log back into the portal, and you forgot to record the first update from earlier in the morning. You re-record your notes. You repeat this over the next several minutes. The phone rings – again. Another family and another fire to put out.
By the time you finish this call, a pop-up appears on your screen. It is the reminder that the finance meeting is tomorrow. You need to have updated notes ready for tomorrow’s meeting. You need to look prepared for your presentation.
Throughout the day more distractions and disruptions occur until it is time to go back home. You realize you will not be prepared. You need a glass of wine (I would recommend a glass of Cabernet Sauvignon, 2014 was a great year) in order to relieve your stress and frustration.
What I have described is the typical business office manager/biller’s day. When compounded, the business office follows the path of disruption --> stress --> confusion and/or frustration. The result – the facility’s accounts receivable grows until it is no longer collectable and you must write off the balance.
If you are a biller, business office manager or an administrator then you deserve a solution that will help you eliminate disruptions, prevent your AR from growing and allow you to stay focused on your more fulfilling responsibilities.
As you read this article, I want you to imagine still being able to drink that glass of wine – not in frustration but in relaxation. Specifically, I want to share with you the benefits of our application, which allows you to bypass distractions and never have to worry about your AR growing again.
REVEX Application
The REVEX application is a cloud-based software that allows for seamless communication between billers, payers and the business office. This means you have a simple and interactive AR portal that allows you to retrieve claim status information in one location – rather than having to synthesize the information across multiple platforms and billers. That is what makes our application unique; it integrates the complexity of automation with the reliability and talents of skilled medical billers.
First, we have over thirty billers on staff to address specific payers. This allows us to help you fix claims should the need arise.
Second, we incorporate hyper-automation into the claim follow-ups. The hyper-automation design reduces the burden of mundane and repetitive tasks such as logging into a portal, updating notes and so on [1].
By blending these two items together, we are able to streamline the follow-up process, which allows our team (and customers) to focus on their core responsibilities.
How we use it to tackle the mundane
Most billers underestimate the actual time it takes to check on claims, correct claims and document their follow-ups. In many instances, very few of us (myself included) have ever really taken the time to record how long it takes to flip between screens, save notes, etc.
Although flipping through screens may only take a few seconds – these seconds build up over time. If you have one hundred claims you need to update then you may budget about two hours to check the status and update your notes. Add in all of the disruptions and those two hours are spreading out throughout the day.
Therefore, we decided to design our hyper-automation program ROXY (we named her ROXY – because of how she ROCKS at updating claim statuses) to take on the preliminary follow-ups.
For example, let us say we have one hundred claims to check with Medicaid. Once I hit the “run update” ROXY will review the corresponding notes, check the claims and record a new note – all in a few minutes. So, instead of me spending anywhere between sixty to ninety minutes checking on these claims ROXY achieves this in a fraction of the time.
The Advantages of Hyper-Automation
The first advantage of hyper-automation is that it increases the accuracy of the follow-Ups. Once you define the steps, ROXY must follow each of them in order to complete the updates. This means that each account will be updated exactly the same way and reflect the information available in the portal.
- For example, every claim reported in the PAID status on the insurance portal contains a unique claim number and EFT number. These numbers can be fifteen digits long. ROXY will make sure each digit is transposed exactly as it is in the portal.
Additionally, ROXY has a database of automated responses. This means the notes will be free from typos and clerical errors and guarantees the information recorded in the notes will match the information from the portal.
Likewise, ROXY has a built-in database of notes to use based on the situation. For example, if a claim denies then ROXY’s note will be different from a claim in the PAID or PENDING status. This means that regardless of the day or time of the update you can be sure your notes reflect the exact claim status.
- For example, if the Medicare portal indicates a claim is being denied for invalid qualifying hospital stay date then ROXY will add the built-in response (Next Step – Claim denied for invalid QHSD. Need to double check with Admissions/Medical records for hospital dates).
Fourth, hyper-automation allows you to continue working on your other responsibilities. As we mentioned previously, as a medical biller you have other responsibilities and these usually conflict with the time needed to complete the updates. While ROXY runs through the updates, you can focus on your more fulfilling responsibilities – like addressing resident questions, entering payments or leading meetings with the finance committee.
Why Automation is Critical to the Follow-Up Process
Did you know that 5% of claims, on average, are denied each month? Likewise, did you know that most skilled nursing facilities will write-off about 1-3% of their accounts receivable each year because of these monthly denials[2]? As an example, if a facility has $210,000 in monthly charges this means a facility will plan to write-off $75,000 by the end of the year.
The primary reason for the write-offs boil down to one critical component – not having time to correct or resubmit claims.
The standard work-month in skilled nursing is as follows:
- By the second business Day – submit Monthly Medicaid Claims
- By the fifth business day – submit the Part-A and Part-B claims
- By the tenth business day – complete payment posting and month end close.
As a result, the typical business office manager usually will dedicate a few days to follow-ups. Generally, these follow-ups will take place right around month end close or after they post payments to their patient management system.
The problem; however, is that by waiting until they have posted the payments they are missing the opportunity to address the claims earlier in the payment schedule. In addition, the new month’s billing cycle will be starting on top of trying to address any of these denials.
With hyper-automation, and the REVEX application, you are able to run multiple updates throughout each month to pinpoint the claims that you need to address. This will allow you to correct or resubmit claims earlier and prevent your AR from rolling over month-to-month. Imagine having an extra $6000 each month.
How does life look like after hyper-automation?
You are happier! All kidding aside, your life will include a cleaner AR report. Instead of waiting until the remittances are posted you will be able to run an update and re-work the claims earlier in the process. This will allow you to prevent unnecessary write-offs for untimely filing.
You will have less frustration. Instead of being pulled in multiple directions and unable to maintain focus you will be able to reinstall direction to your workflow. All you need to do is allow REVEX to complete the status updates, and complete the next steps on any denied claims. You can even have REVEX fix any denied claims for even more maximized efficiency.
You will have a more efficient and accurate process. Instead of manually checking each claim, flipping through multiple screens and recording your notes one at a time you are now able to simply log in to the REVEX application and read your status updates.
In sum, REVEX supported through the careful blend of automation and skilled billers will allow you to have clarity in the next steps you need to take to keep the AR as clean as possible. All it takes is five minutes – you click update, and five minutes later, you can have all of your accounts updated. With your accounts automatically updated you can save $75K in write-offs and endless headaches.
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Thanks so much for reading!
[1] https://www.investopedia.com/terms/r/robotic-process-automation-rpa.asp
[2] https://managemypractice.com/the-right-way-to-do-write-offs/
