Manual data entry errors, coding mistakes, or even denied claims may seem like minor operational issues. But when they come together, they significantly impact both your practice’s revenue and the quality of patient care!
According to the research, up to 20% of claims are denied on the first submission. Issues like incomplete documentation and medical coding errors become the primary reason for claim denials[i]. Imagine treating a patient and submitting a claim only to have it denied due to some manual medical billing error. This would not only add to your administrative workload but also delay patient care.
Physicians often find themselves busy with medical billing complexities. This often pulls their attention away from their primary focus, patient care. In such a situation, modern Revenue Cycle Management (RCM) software can make all the difference!
RCM software leverages automation, analytics, and real-time verification tools to target various billing challenges. Read on to learn more about billing challenges medical practices face and how reliable RCM software can be the ideal solution.
Key Takeaways
● In modern healthcare, efficient revenue cycle management has become crucial in a practice’s successful financial management.
● Modern RCM systems leverage automation, analytics, and real-time verification tools to target various billing challenges.
● Modern EHRs use AI tools like AI Claim Editor, AI Scanner, and AI Agents in their revenue cycle management.
How RCM Software Addresses Medical Billing Challenges?
Modern Revenue Cycle Management software can tackle medical billing challenges by leveraging the latest technology. Here are some of the most common challenges in medical billing that RCM software can help solve!
1. Manual Errors and Coding Mistakes Delaying Payments
As a doctor, you might believe your priority should be focusing on your patients rather than being bogged down with administrative work; you are absolutely right. But the truth is, manual data entry not only causes typo errors but also wreaks havoc on payments. It also triggers claim denials and consistent resubmissions by weeks and months.
How Does RCM Eliminate Manual Errors in Medical Billing?
When you are seeing several patients, your mind often confuses whether your note supports Z00.00 or Z01.00? That’s exactly where RCM-supported AI Scanner comes into play!
AI Scanner is a part of Practice EHR’s comprehensive suite of AI tools that automatically reads and extracts exact key information from scanned documents with zero chances of any error. The process is not only time-efficient but also increases the chances of claim submission.
2. Claim Denials and Resubmissions
According to the research, it has been estimated that approximately 20% of the claims are denied in the first submission, hampering reimbursements[iii]. This is mainly due to incomplete information or errors in finances and codes. Errors in coding, data entry, or finances can ultimately lead to claim denials that pile up over time.
How Does RCM Reduce Claim Denials and Resubmissions?
Modern EHRs, like Practice EHR, use tools like AI Claim Editor in their RCM software. To make the process stress-free and a lot less time-consuming, EHRs integrate an AI claim editor for smooth and faster claim submissions. The AI Claim Editor does this by reviewing the claims and catching any errors before submission.
Additionally, a study by Cornell University revealed that AI-driven predictive models in RCM, such as “Deep Claim,” have been created to predict claim acceptance chances[ii]. Such AI tools now also highlight the probability of claim rejections.
3. Long Accounts Receivable (AR) Days
Long AR cycles and delayed payments can often be huge obstacles to a healthy revenue cycle and cash flow. Practices struggle with cash flow shortages when claim submissions take weeks or even months to get processed. Many physicians also lack real-time analytics to view claims that have not been accepted or take the longest time.
How Does RCM Software Reduce AR Days?
Modern revenue cycle management software, like Practice EHR, solves this challenge with automated payment posting and claim tracking tools. A robust revenue cycle management system provides the physician with a centralized A/R dashboard. This helps the physician to easily access the claim aging and outstanding payments reports.
Automated follow-up reminders through AI agents (the latest AI innovation) also keep the billing team vigilant, prioritizing overdue accounts. A study on RCM shows that optimized revenue cycles increase cash flows by reducing A/R days[iv].
4. Insurance Eligibility and Verification Issues
One of the most common causes of claim denial or resubmission is inaccurate or missed information in eligibility verification.
When a staff member fails to verify a patient’s eligibility, it not only results in claim rejections and delayed payments but also leads to patient dissatisfaction. Manual verification also slows down front desk operations and affects a practice’s reputation.
How Does RCM Software Solve Verification Issues?
Revenue cycle management software uses an automated eligibility verification system, which checks patient insurance coverage before the services are provided.
Physicians are automatically connected to the payers for patient verification in real time. E-verification in any RCM is a reliable tool to minimize claim rejections and improve the practice’s revenue.
Transform your Revenue Cycle With Practice EHR’s RCM Software
In modern healthcare, efficient revenue cycle management is essential in ensuring a practice’s financial success. From automated code validation to claim denial management, RCM software ensures healthcare revenue optimization.
If you also want to maximize the benefits of revenue cycle management for your practice, consider Practice EHR. The all-in-one AI EHR software has been assisting private practices across the United States in optimizing their revenue and overcoming medical billing challenges.
FAQs
1. Why do my claims get denied?
Common reasons your claims keep getting denied include manual data entry errors, missing information, eligibility verification issues, and coded errors.
2. What are Accounts Receivable days in medical billing?
AR days refer to the number of days practices wait for the reimbursement from the health insurance companies after submitting a claim. Lower AR days mean the billing cycle is working well.
3. How does RCM software help reduce claim denials?
Modern EHRs now use AI-integrated RCM systems to detect and correct manual errors before the claims leave the clearinghouse. This drastically reduces the chances of claim denials.
REFERENCES
I. Conifer Health Solutions. (2024, December 10). Physician billing services guide: From denials to revenue recovery.
https://www.coniferhealth.com/knowledge-center/physician-billing-services-guide-fro m-denials-to-revenue-recovery/
II. Kim, B.-H., Sridharan, S., Atwal, A., & Ganapathi, V. (2020). Deep Claim: Payer response prediction from claims data with deep learning. arXiv.
https://doi.org/10.48550/arXiv.2007.06229
III. Poland, L., & Harihara, S. (2022, April 25). Claims denials: A step-by-step approach to resolution. Journal of AHIMA.
https://journal.ahima.org/page/claims-denials-a-step-by-step-approach-to-resolution
IV. Chandawarkar, R., Nadkarni, P., Barmash, E., Thomas, S., Capek, A., Casey, K., & Carradero, F. (2024). Revenue cycle management: The art and the science. Plastic & Reconstructive Surgery Global Open, 12(7), e5756.
