It’s no secret claims and denials management are both a stressor and a key area of focus for healthcare leaders moving into 2024. A recent Change Healthcare study found almost 86 percent of denials are potentially avoidable, while in 65 percent of cases, providers don’t resubmit denied claims. In a climate where revenue is critical and competition high, practices need every advantage they can to collect the most amount of money possible through their claims processes.
Now, cue healthtech—innovation around AI, automation and intelligent workflow tools is expanding, contributing to a welcomed shift in revenue cycle management. In fact, we expect to see a number of trends around RCM this year, as data transparency, staffing challenges and administrative burden continue to plague almost all facets of healthcare.
With that said, these are the top three trends we at Encoda predict will impact claims and denials management this year.
1. Embracing data transparency to glean insight into the medical billing process. Due to outsourcing and fragmented processes, it’s typical for practices to have limited access to the data concerning their claims and denials. In fact, among today’s cloud hosting vendors, it’s common to lock data down, ultimately restricting data flow and partnerships with clearinghouses. In turn, the process itself contradicts healthcare’s current quest for an open and interactive exchange of data, creating not just silos, but also limitations around what medical practices actually have access to.
As the conversations around tech-enabled RCM and data transparency continue to evolve, we expect to see best-in-class solutions bucking the trend of data restriction and limitations around clearinghouses—and instead provide value to practices by offering true transparency.
In fact, that’s one of the founding principles of Encoda. Using Encoda’s intelligence workflow tool, medical practices receive full transparency into their claims data providing insights, allowing them to glean trends, see why and where denials have occurred, and even gauge employee productivity. Clients of Encoda have the ability to view their EDI workflow data in the same way they interact with their practice management and clearinghouse systems, providing value through decreased denials and faster time to reimbursement.
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2. Innovative solutions for today’s severe staffing challenges. One challenge becoming increasingly common among today’s practices is the inability to keep quality staff on board, and as a result, practice leaders find themselves needing to operate with sometimes half of the staff they had. As the budget for the back office keeps shrinking, we see the need for innovation around these types of processes, to create an environment that’s not just efficient but also accurate.
But it’s not just limited staffing that impacts the claims process and your denial rates. At Encoda, we hope to see a positive shift in the investment into medical billing teams and tools within a practice environment. Combined with today’s leading RCM solutions, education around the billing process should be a top priority, which could help lower employee turnover.
However, until that becomes a reality, practices are faced with either outsourcing certain aspects—if not all—of their medical billing processes, or innovating with tech. With Encoda, for instance, practices can work on their claims all in one place, without needing to outsource. Our rules-based software engine identifies and places problematic claims and remittances in one intuitive work queue, enabling billing teams to work rejections and denials faster and more profitably.
“Essentially, we’re a middleware product but we do our best to be good stewards of the information we’re expected to manage and make available, which is one of the other ways the industry has changed. It’s gone from every medical practice running their own computer system to the cloud, which is really paying someone else to run your computer.” — Bronson Cox, Co-Founder, Encoda
3. Automation that streamlines outdated paper processes. At Encoda, we often hear from practice leaders being “let down” by their current processes; it’s common for sticky notes around a monitor to supplement automation when it comes to nuances in a billing process. However, for a multi-practice organization with multiple practice management systems, dated paper processes are no longer feasible, which we predict will lead to an uptick in automation through platforms like Encoda.
For instance, our solution is fully customizable, allowing “sticky note” rules to be created and applied to each client’s individual billing process. Encoda’s software acts as the “middleman” between practice management systems, clearinghouses and payers, enabling not just data transparency but also interoperability. In turn, billing processes are streamlined, limiting delays in claim submission and issue resolution while promoting revenue capture. In fact, one Encoda’s clients saw their revenue increase 33 percent, creating an additional $50,000 a month in medical payments, through the use of our software.
“In today’s competitive market, it is vital that medical practices and physicians are prepared to increase their net collections and capture every dollar they can out of insurance claim submissions.“ — Lisa Taylor, CEO of Encoda
Concerned about your revenue cycle this year? Learn more about the leading claims and denials management system—and how it can help your practice.
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