Gaining Efficiency and Accuracy in Medical Billing by Overcoming Manual Processes

Each year, U.S. healthcare providers spend billions of dollars on filing medical claims and billing - from verifying insurance coverage to appealing denials. Studies have shown that healthcare organizations spend more than $10 billion annually on insurance authorizations and $20 billion contesting denials.¹ And those costs continue to rise.

While rising costs can seem overwhelming, there are steps that can be taken to make billing processes more efficient and accurate. Most notably, organizations can reduce manual processes to lower the money and time spent on insurance verification and remittance, all while preventing denials to keep the revenue cycle healthy.

Here's how organizations can achieve more efficient - and cost-effective - medical billing processes.

Verify all sources of insurance faster

Providers know that one of the most time-consuming elements of the medical billing process is identifying and verifying insurance coverage. When staff do this manually, they have to reach out to payers via a web portal or the phone to verify that coverage is up to date to ensure that services are covered and to determine the individual's financial responsibility for care.

Automated insurance verification can accelerate this process and accurately find all sources of coverage. Staff can use one dashboard to check eligibility across payers and perform batch verifications, checking eligibility for multiple patients or residents at a time without needing to input demographics over and over again. Additionally, insurance verification software can spot changes in eligibility that the patient or resident themselves may not have been aware of before the claim goes out the door.

Automatically correct errors to file cleaner claims

There are many factors that lead to denials, and for billing staff, one of the best ways to combat lost or delayed revenue due to denials is to focus on clean claims. But manually examining claims to verify that changes don't need to be made before submission can be time-consuming and costly. Automated claims processing can help.

With automation, staff can save time - and avoid the risk for error - with software that fills in patient or resident demographics. Claims software can also scan claims to check for missing demographics, improper coding, and other errors that can lead to denials. Perhaps most importantly, automated claims processing can examine claims against the most up-to-date CMS and commercial payer rules, saving staff from constantly reviewing rule changes and claims manually. When a problem with a claim is spotted, staff are directed to the problem, allowing them to quickly correct the claim to improve the chance of first-pass acceptance.

In addition to fixing some claims problems automatically, claims management software can help organizations improve billing by identifying trends in the billing cycle that are jeopardizing claims.

Shorten days in A/R with quick resolution

Of course, the primary goal in medical billing is to quickly and accurately submit claims to avoid denials. And the importance of avoiding denials is clear - it costs an average of $44 per claim to rework or appeal a denial.² Perhaps even more damaging to providers' revenue cycle, 46% of denials are upheld, leading to a loss in revenue for healthcare organizations.²

Fortunately, automation can prove invaluable in addressing denials. When denials happen, claims software can automatically deliver the denial back to the billing team for corrections. Staff are quickly alerted of the denial and provided with step-by-step instructions on reworking and resubmitting the claim. Not only can automated denial resolution improve the revenue cycle, but it can eliminate surprise bills for patients and residents, leading to a more positive healthcare experience.

Maximize billing cycle efficiency with centralized remittance

One of the most cumbersome processes in medical billing is remittance. As billing staff know, manual remittance can involve visiting multiple payer portals and clearinghouses, processing paper remits, and scanning, downloading, and printing paperwork.

That's where automation can help. With an automated electronic remittance process, billing staff can access ERAs from all payers in one location. This can eliminate multiple workflows, and it allows staff to download and save the necessary documents in one location for future reference. When staff does need to recall a remit, they will find it in a searchable database, so they don't have to waste time combing through files.

Overcoming manual processes in medical billing

Increasingly, providers are discovering how reducing manual processes with automated, SaaS-based workflows can improve medical billing by saving staff time, reducing errors, and improving the patient or resident experience.

Discover how Inovalon can help your organization overcome manual billing processes with front-end and back-end revenue cycle management solutions.

1. "America's Hospitals and Health Systems Continue to Face Escalating Operational Costs and Economic Pressures as They Care for Patients and Communities," American Hospital Association, May 2024, https://www.aha.org/costsofcaring
2. "Trend Alert: Private Payers Retain Profits by Refusing or Delaying Legitimate Medical Claims," Premier Inc., March 21, 2024, https://premierinc.com/newsroom/blog/trend-alert-private-payers-retain-profits-by-refusing-or-delaying-legitimate-medical-claims

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