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Benefits of Finding a Partner for High-Volume Claim Environments

By May 31, 2024June 5th, 2024No Comments

A high-volume claim environment is characterized by the continuous influx of a large number of claims, often stemming from extensive patient care services, diverse treatment offerings, or large-scale operations such as hospitals, multi-specialty clinics and ambulatory surgery centers (ASCs).

Managing this deluge of claims is crucial to maintaining financial stability and ensuring timely reimbursements. However, the complexity and volume can overwhelm in-house teams, leading to errors, delays, increased denials and claims not being reworked.

Organizations operating in such environments can greatly benefit from partnering with a revenue cycle management (RCM) company that utilizes advanced, AI-driven technology.

Here are a few key benefits.

Improved Accuracy and Reduced Errors

Errors in claims processing can lead to denials, delays, and revenue losses. Even a small error rate can translate into significant financial losses in high-volume settings.

And, in a world where it’s becoming increasingly difficult to get payers to pay you, partnering with a company that utilizes AI-driven RCM technology can maximize your revenue and minimize disruptions.

Using a mix of technology and expertise in coding, compliance, and documentation reduces the likelihood of errors and ensures that your organization can process large numbers of claims without incident.

Comprehensive Denial Management

Considering that claim denial rates grew from 10.15% in 2020 to 11.2% in 2022 and then to 11.99% in 2023, it’s safe to say denial management is a significant challenge for all healthcare organizations.

However, those that receive large amounts of claims are even more vulnerable to financial losses and operational disruptions caused by these denials.

The right RCM partner should provide comprehensive denial management services that identify the root causes of denials and implement corrective actions, no matter your claim amount.

For example, our collections and denial management system uses machine learning (ML) from historical data to map reasons for denials and provide the most appropriate responses—promoting quick turnarounds and one-touch fixes.

In one instance, a healthcare provider used our collections and denial management system to:

  • Improve billing turnaround time from 7 to 4 days
  • Reduce their amount of claims in 90+ days in A/R from 40% to 15%
  • Reduce days in A/R from 49 to 25
  • Boost their clean claim rate to 99%

Scalability and Flexibility

High-volume claim environments often experience fluctuations in the number of claims due to factors such as seasonality, changes in patient volume, or shifts in healthcare policies.

While it may be difficult for your in-house operations to quickly scale up or down, an RCM partner can provide the necessary scalability and flexibility to manage these variations efficiently without you needing to invest in additional resources.

Faster Claim Turnaround

Timely processing of claims is crucial for maintaining a healthy cash flow and reducing cost-to-collect.

An RCM partner can significantly speed up the claims process by leveraging AI-driven automation and streamlined workflows to ensure claims are submitted and processed more quickly and reduce the likelihood of errors that could lead to costly denials.

With faster turnaround times, your practice can maintain a steady revenue stream and improve financial stability. Additionally, quicker claim resolutions enhance patient satisfaction by reducing billing-related frustrations and providing clearer, more accurate billing information.

Data-Driven Decision Making

Data becomes a crucial asset for driving efficiency and improvements in an organization dealing with a high volume of claims.

With an RCM partner, you can leverage AI-driven analytics to provide actionable insights into your revenue cycle performance. These insights can help you identify trends, pinpoint areas for improvement, and make informed decisions to enhance your financial health.

Whether optimizing your payer mix, reducing claim denial rates, or improving patient collections, data-driven decision-making is critical to achieving your revenue goals.

Compliance and Regulatory Expertise

Navigating the complex landscape of healthcare regulations and payer requirements is challenging, especially in high-volume environments.

RCM partners stay abreast of the latest changes in healthcare laws, payer policies, and coding updates. Their expertise ensures that claims comply with current regulations, reducing the risk of audits and penalties. This compliance expertise protects healthcare providers from potential legal and financial repercussions.

Your Partner for RCM Success

Looking for an RCM partner to help your organization thrive within a high-volume claim environment?

Let us show you exactly how we could help via a free opportunity assessment.