Claim management is a complex and demanding process. From accurately documenting visit notes to validating, submitting, and ultimately accepting claims, it’s easy for small claims to get overlooked amid the pursuit of larger ones. Billers often prioritize big claims, those exceeding a certain threshold like $60, understandably due to the time-consuming nature of claim submission, denial identification, and resubmission. In this article, we emphasize that small claims are equally as important as big claims, as the cumulative impact of these overlooked charges significantly affects the entire revenue stream.
Why Small Claims Matter
Out of $3 trillion in submitted medical claims, healthcare organizations deny an average of $262 billion annually. That is around $5 million per provider.
Around 65% of medical claim denials never get resubmitted. This also includes denials regarding commercial health plans. Adding to the hit on the bottom line is the cost to rework or appeal denials, which averages $25 per claim for practices and a whopping $181 per claim for hospitals. This means even the smallest of the claims cumulatively greatly affect the revenue stream. Populate aims to make the claim management process easier by providing advanced and tailored solutions to our users.
Ways to Avoid Claim Rejection
1. Identifying the common reasons behind small claims rejection
Here are a few common reasons claims get denied according to the MGMA:
- Needing prior approval: If you don’t get approval before a service, the claim might get denied.
- Missing or wrong information: If there are empty fields or mistakes in the info, like the Social Security Number or plan code, the claim could be rejected.
- Not meeting medical necessity: If the service isn’t medically necessary or the payer disagrees with the doctor about what is needed, the claim might not be covered.
- Service not covered: Reviewing the patient’s plan or checking with their insurer before sending the claim can prevent this.
- Provider not in the network: The claim could be denied if the service is done by someone out-of-network.
- Duplicate claims: Sending more than one claim for the same thing on the same day for the same patient and provider can cause problems.
- Coordination of benefits: If a patient has multiple health plans, sorting out who pays what can cause delays or denials.
- Already included services: If a service is already covered in another payment, the claim might be adjusted.
- Late filing: Claims filed after the deadline set by the payer might get rejected, so it’s important to consider this when fixing rejected claims.
2. Calculating the Cost of Claim Rejections: Sorting and Identifying Expenses
3. Educating Staff to Reduce Small Claim Denials
We care about your small claims:
At Populate, we prioritize simplifying the claims process to benefit our users. We aim to ease the workload for billers and claim submitters alike. By providing features that save time and enhance efficiency, we empower users to concentrate on smaller claims, leading to increased revenue and smoother claims management. Key features include:
- Automatically populating claims with billing information significantly reduces the chance of errors, ensuring accuracy and efficiency in the submission process.
- Our intuitive platform allows users to easily check the status and progress of their claims, providing transparency and peace of mind.
- The ability to split a claim from the same module enables users to manage complex billing scenarios with ease, optimizing workflow and productivity.
- Sending secondary claims is made simple, facilitating efficient reimbursement for services rendered.
- For those occasions when a printed claim is necessary, our platform allows users to generate CMS-1500 forms effortlessly, saving time and hassle.
- Users can conveniently view claim adjustment amounts and explanations, empowering them to understand and manage claim discrepancies effectively.
- Our tracking feature provides a detailed breakdown of claims provided in the system enabling users to reconcile payments accurately.
- Finally, our platform allows for the seamless sending of Patient Statements to patients via email or phone, enhancing communication and transparency in the billing process.
Conclusion
In conclusion, effectively managing healthcare claims, big or small, is crucial for financial stability. Overlooking small claims can add up, impacting revenue significantly. Identifying common reasons for claim denials and training staff on efficient claim handling are key. Populate provides practical solutions to streamline the process, ensuring accuracy and transparency. With Populate, healthcare providers can maximize revenue and financial health by focusing on every claim, big or small.