For urgent care organizations looking to ensure prompt payment and a healthy revenue cycle, efficient and accurate claim submissions are absolutely essential. Unfortunately, traditional claim submission processes contain plenty of room for error and often result in payment delays and claim denials.
However, by optimizing claim submission in the front end of your revenue cycle management process—beginning when the patient first shares their name to make an appointment—you can speed up payments, improve cash flow and profitability, minimize errors, and streamline revenue cycle management.
Here’s everything you need to know about improving your financial performance and operational efficiency with optimized claim submission:
The Challenges of Traditional Claim Submission
Far too often, traditional claim submission processes result in payment delays and even worse—claim rejections and denials. Estimates from the Medical Group Management Association (MGMA) suggest that every rejected or denied claim costs a practice an average of $25 to rework.
Insurers frequently reject claims submitted by healthcare providers for a multitude of reasons, including if the claim contains billing code errors, is missing information, doesn’t meet specific criteria, or is late.
When relying on paper-based documentation and manual submissions, late filing can be hard to avoid due to simple factors like individual oversight or even just a backlog in the office. Other common roadblocks include clearinghouse issues and problems with coordination of benefits.
In a recent study of urgent care organizations by the Urgent Care Association, more than 55% of respondents said registration errors preventing clean claims is their leading revenue cycle management challenge. And nearly 50% of respondents said their most common reason for claim denials is the wrong insurance being billed. Meanwhile, a Solv survey found that around 44% of patients enter incorrect address information, which contributes to downstream clerical issues.
Strategies for Optimizing Claim Submission
Optimizing your urgent care clinic’s claim submission process brings cost savings and a heavily reduced administrative burden, among other benefits. Here are some strategies for making it happen:
Avoid Late Filing
Since most claims will be denied if filed past the deadline, it’s important for your urgent care clinic to have systems in place that ensure all claims are submitted on time and received by the payer. One way to make sure nothing falls through the cracks is to submit claims electronically and physically.
Train Your Staff
Proper staff training is key as you optimize your claims submissions process. Consider investing in ongoing training so your staff is well versed in everything they need to know about billing, coding, documentation requirements, and other aspects of claim submissions. This is a crucial preventive step to help them avoid denied claims and minimize unnecessary rework.
Collect Accurate Patient Information
Leverage the power of technology to collect accurate patient information—including the patient’s name, address, and insurance information—at the time of booking. This minimizes human error.
Make sure to verify insurance coverage before the patient’s visit and validate this important patient data when they stop into your clinic for their appointment. If the patient has coverage across multiple insurance policies, make sure to consider coordination of benefits and factor that into your claim submission process. All of these steps help streamline your process and ensure claims are not rejected or denied.
Audit your Process
Conducting regular audits and quality checks allows you to take a close look at your process. Pay attention to claim denials and rejections. Are you repeatedly making the same coding or documentation errors? Are any common patterns popping up that you can identify and course-correct? Take note of any trends you can address that are increasing your administrative burden and negatively affecting your cash flow.
Harness the Power of Data and AI
Medical billing is complex. Data, artificial intelligence (AI) and machine learning can help identify errors and provide invaluable information about areas of the claim submission process that are holding you back (such as repeated mistakes that continuously lead to claim denials) and how you can optimize and improve. Consider implementing autonomous systems that combine AI and machine learning to improve your coding and billing.
Benefits of Claim Submission Optimization
Here are a few of the leading benefits your urgent care clinic will harness once you optimize claim submissions:
Quicker Payments and Better Cash Flow
By leveraging technology and other means to optimize your claim submissions, you can expedite reimbursement and reduce delays, improving your clinic’s cash flow and leaving you better able to manage your revenue cycle. Any cost savings realized in the process will leave you better positioned for financial and operational success — better equipped to invest in other important areas of your business, like medical equipment and staff training.
Fewer Denied Claims
Claim denials present a significant roadblock for your urgent care clinic by reducing or delaying payments, ticking up unnecessary administrative costs, and wasting time. Optimizing your claims process allows you to actively put systems in place that minimize claim rejections and denials.
Monitoring and Continuous Improvement
Claim submission optimization isn’t a “one and done” type of undertaking. Instead, you’ll want to continuously monitor your process and look for ways to improve. You can do so by:
- Tracking metrics and performance indicators related to claim submissions.
- Conducting regular data analysis and leveraging this information to identify areas for improvement.
- Using learnings from customers, employees, and other important stakeholders to implement feedback loops and refine your process.
Optimizing your claim submission process may initially feel like an overwhelming and burdensome undertaking. But diving in to make this important change can bring substantial benefits for your urgent care clinic, including significant cost savings, faster payments, a heavily reduced administrative burden, and a better patient experience.
Learn more about how Solv can help you improve your financial performance and operational efficiency with optimized claim submission.