Improving the claims submission process has paid benefits for a hospital chain as it seeks to improve its facilities' performances.
And Michael De La Garza expects that improving the claims process will be important for all providers as deductibles rise and consumers shoulder more responsibility for the cost of their care.
The CIO of Renaissance Healthcare Systems Inc., which operates four hospitals based out of Houston, De La Garza cares deeply about improving claims submission and collection – his organization's business model is to acquire struggling hospitals and turn them around.
A variety of other strategies come into play, but getting payment for services, and quickly, is a significant step in making facilities viable.
Last April, Renaissance installed the Pro837 claim editor from ClaimRemedi Services Inc., a Los Angeles-based company with applications and services aimed at revenue cycle management.
Renaissance has used the claims editing capabilities to improve collections. After six months on the application, it improved its first-pass acceptance rate to 99 percent, up from about 44 percent in April, De La Garza said.
Improved collections allowed the chain to save money by reducing the need for collectors and reassigning staff who had been reworking claims.
Renaissance can now be more timely in seeking payments from patients.
"Most people have a hard time paying you after 90 days because they think you're incompetent," De La Garza said. "This has enabled us to work the self-pay portion much earlier."
Renaissance can now set up payment plans with patients, including automatic payment plans. "If you give patients the opportunity to make payments over time, most patients will cooperate," De La Garza said.
Renaissance also handles billing for 300 physicians. While physician office problems differ in scope, many smaller providers can benefit from claims editing assistance in increasing claims acceptance rates.
Using the ClaimRemedi application has given Charleston, W.Va.-based Health Data Solutions Inc. a "foolproof way of meeting what the payer wants," said Robin Roach, the company's CEO.
Health Data Solutions provides revenue cycle management services for specialty and group practices. The application has improved HDS' first-pass claims approval rate to more than 99 percent, Roach said.