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Third-Party Payor Differences Can Slow Your Revenue Stream

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When it comes to your reimbursements, knowledge is key to receiving maximum payment for services rendered. Here we address how third-party payor differences and legislative policies can slow your revenue stream, and provide revenue cycle management suggestions you can employ to your ensure accurate, timely reimbursements.

Slow reimbursements add up to lost revenue

Tiny details in how payors process claims — such as when they change claims requirements, A/R and reimbursement schedules, and the specifics of appeals windows — are essential to the health of your revenue stream. If you don’t know each of these details then you can’t fully understand why some of your reimbursements are slow. You also won’t be able to get to the bottom of lost revenue.

Accounts receivable disparities among payors

 A recent survey of five of the nation’s largest commercial managed-care payors found disparities in how each pays claims. Although physician practices and hospitals may be improving how they submit claims, differing internal processes in each payor appear to be delaying payments. Using a measure of “true AR days” — described as “a measure of gross receivable with contractuals taken at the time of billing added back in” — the survey found that payors ranged from 52.2 days to 67.7 days for payouts. Such delays are a major stumbling block to your revenue stream.

CMS rule and physician reimbursement gap

 Another detail that has implications for your revenue is related to recent Centers for Medicaid and Medicare Services (CMS) actions attempting to stabilize the Affordable Care Act individual and small-group insurance markets. On April 18, 2017, the American Medical Association reported on a final rule issued by CMS that would:

…bar an individual from enrolling in any of an exchange insurer’s products until past-due premiums are paid. Physicians are caught up in a complication caused by the grace-period regulation that leaves a patient still eligible for coverage — provided the past-due amount is paid — but can render the physician unable to collect from the insurer for two months of claims if the debt is never cleared.

These types of details can derail the revenue system of even the best practice. The only protection you have is to ensure that your medical billing system is efficient and highly accurate so that the revenue-generating processes within your control are rock solid.

Clean claims and denials

 This brings us to the question of claims and whether you are submitting them accurately, tracking them, and managing denials. Practices and hospitals should contact a payor within two weeks to one month of claims submissions to facilitate Accounts Receivable. If your practice generates a lot of claims, it might be beneficial for you to build a relationship with one person at each payor’s office. That can help ensure that payment requirements are being followed on both sides — and that payments aren’t being held beyond the legal time limits. It will also be useful if you discover you are being paid less than the contracted amount.

When it comes to denials, you will need to look at each claim line to determine the reason for the denial. Did the errors occur during preauthorization? Was it a coding error? Once you identify where the errors occurred, you can fine-tune back-end systems to reduce recurrence and improve the rate of successful claims.

Importance of a reliable billing system

Each payor is intricate, and the vast variations in their requirements can slow down your reimbursements. The only constant for your practice or hospital is to have a reliable medical billing system that becomes the pillar of your revenue stream. Your success will depend upon the timely completion of tasks and skilled handling of details.

At Infinx, our knowledge of all payor requirements gives us the power to quickly and accurately navigate through these details to ensure you get paid on time. Combined with our preauthorization software, iBridge, and certified claims processing teams, we provide an end-to-end RCM solution for hospitals and practices of all sizes.

InfinxThird-Party Payor Differences Can Slow Your Revenue Stream

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