Enhancing Hospital Revenue Cycle – The Impact of Effective A/R Follow-Up in Medical Billing
Medical billing is a complex process and requires extensive knowledge in many sectors, as well as attention to detail. Accounts receivable (A/R) follow-ups are impactful for many hospital sectors. The tracking process and resolving outstanding, underpaid, and unpaid claims with payers can be exhausting and tedious. Healthcare claim denials are on the rise, with an average in-network claims denial rate of 16.6% (Pollitz, et al, 2023). This means follow-up and denial management are crucial for keeping a hospital’s A/R days down and revenue cycle on track.
Claim Tracking
Unpaid and underpaid claims happen because of contractual billing, coding errors, or miscommunication between the payer and the hospital. If a claim is not being tracked, an underpaid claim can go unnoticed and outstanding claims continue to age. Unpaid claims are usually due to a denial, and when claims aren’t properly tracked it makes the appeals process difficult.
Denial Management
Provider claims are denied for several reasons, ranging from prior authorizations to improper coding and insufficient personnel. The effects of denied claims negatively impact a hospital’s revenue cycle management by extending financial recovery times and outcomes. In fact, “35% of hospitals and health systems report $50 Million or more in foregone revenue as a result of denied claims once appeals have been exhausted (Report, American Hospital Association, 2022). Denials management is complex, and many things make successful revenue recovery difficult. Payers are denying in larger volume of claims, RPA has allowed payers to change rules and regulations more easily, and the requirements of prior authorizations, requests for information, and medical necessity denials are trending upward.
Securing experts and training your staff to navigate provider denials can be strenuous on hospital revenues and operations. Even hospitals that have dedicated staff for claim denials lose revenue due to improper follow-up. Not all employees have the training and knowledge to correctly appeal claim decisions. Differences in requirements for providers and individual states make streamlining processes problematic, which can lead to a longer appeals process and greater A/R days in general. Preventing denials is essential to a hospital’s overall revenue cycle success.
Outsource Revenue Cycle Management Services
Hospital systems that strategically partner with a Revenue Cycle Management services company have greater access to real experts and their customization, innovation, and collaboration, leading to maximized revenue.
Hospitals that use experts for claim management and revenue recovery are positioned at an advantage. NYX Health is a Revenue Cycle Management solution company providing comprehensive services for individual healthcare facilities, hospitals, and hospital systems. Our services include medical coding, eligibility and enrollment, a/r recovery services, and prior authorizations. NYX Health employs experts in comprehensive clinical, technological, and financial services. NYX Health provides a customizable suite of solutions that address each hospital’s specific needs and challenges in the ever-evolving regulatory environment. NYX Health enables their partners to focus on the mission of their facilities, while they efficiently and strategically ensure streamlined services and revenue growth for the hospital. For additional information please call (866) 826-1539 , email [email protected], or visit nyxhealth.com.
