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1. Not staying current with payer requirements
Just reading your insurer's newsletter isn't enough. In many instances – such as a change in structure of provider identification numbers – you can't just resubmit the claim. Your system must be updated first to support the payer's modification, which requires administrative time and further delays payment.
Bottom-line impact: Sluggish cash flow, high claim reject rates and administrative expense.
2. Failure to monitor the entire claims process
If you can't manage the claims process at every point in its lifecycle, you can't identify where it went astray and resolve the issue. Without automated alerts as to why a payer is routinely denying claims for a given procedure or code, your staff will spend countless hours researching the issue.
Bottom line impact: Lagging accounts receivable and high administrative costs.
3. Not resubmitting rejected claims
When claims are rejected due to coding errors, many providers are reluctant to resubmit to certain payers because they lack access to data that can support the challenge.
Bottom line impact: Lost revenue.
4. Failure to verify patient eligibility
One-quarter of practices never verify patient eligibility and copay amounts. Further, another one-quarter don't bother to check until the patient has left the office. As copays climb and patients make multiple office visits, verifying eligibility is a critical step to managing your revenue.
Bottom line impact: Reduced revenue and increased bad debt write-offs.
5. Not recognizing trends
Busy practices with heavy administrative workloads tend to process claims one at a time. When claims are addressed individually, administrators often fail to see high-level, macro trends and make the same processing error repeatedly.
Bottom line impact: Slow payment and increased administrative time and expense.