Claim submission and denial management are critical components to the revenue cycle of healthcare facilities. As regulations are getting more stringent with the transition to value-based care, healthcare providers are facing an increase in claim denials. It therefore comes as a surprise that nearly one-third of clinicians are still using manual processes to manage their claim denials.
April 28, 2016 witnessed the release of the proposed rule that is intended to guide the implementation of MACRA (Medicare Access and CHIP Reauthorization Act of 2015) which aims to reward clinicians and physicians engaging in activities that support and drive positive patient outcomes. MACRA, once implemented in totality, will change the way physicians taking care of Medicare patients are paid by CMS.
The increase in audits has made them more of a rule than an exception. Each year, approximately 9% of physicians undergo a RAC audit. According to projections, within the next eleven years, every eligible physician will face a RAC audit. Insurance companies and government agencies are using the audit to recover improper claims payments as the rising cost of healthcare is impacting their bottom lines like never before.
In order to keep your practice afloat, it is imperative that your services receive full and timely reimbursements. Getting your cash flow moving smoothly depends on accurate coding along with timely submission of your bills to the relevant insurance carriers. Incorrect coding can lead to your reimbursements being delayed, denied or rejected. If you have a small or specialty practice,