Electronic Claims Management Can Help Reduce Claim Denials

Claims management is complex. But with the right electronic processing system, teams can manage claims much easier and even reduce the prevalence of claim denials.

blog image

Fast and accurate claims processing is a key concern for healthcare providers, as it leads to prompt, consistent cash flow. To that end, more payers are turning to electronic claims management. Not only does electronic claims management streamline the claims process and ensure prompt provider reimbursement; it also requires fewer staff hours, reduces overhead, and provides better accuracy and fewer denials. There are some caveats to consider before implementing an electronic claims management system, though.

Electronic Claims Management Basics and Benefits

According to the Council for Affordable Quality Healthcare, Inc. (CAQH), healthcare and dental industries have saved $122 billion in expenses by streamlining administration functions. Put simply, electronic claims management is the key to streamlining processes and ensuring cost savings. Providers have been a little slower to fully embrace digital technologies — including electronic health claims — but that is changing.

One of the biggest benefits of electronic claims processing is that it speeds up the revenue cycle and, in turn, cash flow. Faster claims processing increases patient satisfaction. Plus, many commercial insurers, as well as Medicare, require electronic claims submission.

Electronic claims management reduces paperwork and overhead costs. Submitting claims electronically reduces the costs of processing, mailing, and resubmitting a claim, freeing up billing staff for other tasks. It also lets providers, patients, and payers easily track the status of a claim. To make adoption of electronic claims management easier, HIPAA’s Transaction Rule mandated the use of standardized formats for electronic claim transmission.

Although the benefits are plentiful, adopting electronic claims management also comes with obstacles. For example, understanding a claim, including what was paid by payers and how much was paid for each claim line versus what was billed, can be a challenge for healthcare teams. Additionally, because providers typically use multiple revenue cycle management and other IT systems, adding electronic claims management can create a difficult-to-understand patchwork of technologies.

How EHR and electronic claims management can reduce claim denials

Electronic health records (EHR) and electronic claims management are especially helpful is reducing claim denials. EHR and electronic claims make it easier to track and analyze the most common reasons for denials so you can take steps to avoid them. And one of the most common reasons for denials is errors.

EHR and electronic claims management reduces manual entry and can help reduce denials by easing the task of determining which services are considered medically necessary, which require prior authorization, and which require referrals.

Electronic Claims Best Practices

The best way to reap the full benefits of electronic claims management is to take the time to understand it. Unfortunately, many payers do not fully understand the claims process and, in many cases, currently existing systems. To overcome these challenges, it’s important to involve IT staff in the implementation of electronic claims processing. They know the existing infrastructure and can ensure new systems are integrated seamlessly.

Additional best practices for implementing these systems include:

  • Educating providers about documentation requirements.
  • Attaching built-in alerts to an electronic record to ensure necessary data is collected at every encounter and claims are submitted before deadlines to file.
  • Verifying referrals, authorizations, and medical necessity determinations.
  • Using artificial intelligence and other technologies to mine and analyze data to find common errors and reasons for denials.

The EHR and electronic claims process are complex, and trying to understand all the details and requirements can be frustratingly difficult for providers. That’s why many providers outsource their electronic claims processing to a trusted, experienced partner like TruBridge. To learn more, visit TruBridge.com.