As healthcare providers continue to face ever-thinner margins, compounded by a shifting reimbursement model, the pain of monitoring the status of claims has gone from a nagging annoyance to an acute problem. Unfortunately, the approach that many of providers take – making call after call until they learn the final status – doesn’t do much to help their situation.
There are two issues involved. The first is that this manual approach to monitoring claim status requires a significant amount of revenue cycle staff resources and time, often to learn that the claim is progressing normally through the process.
The second is that when there isn’t enough revenue cycle staff to follow up on every claim, healthcare organizations tend to make the highest dollar claims their priority. The problem here is if those claims will be paid without any problems then all that effort dedicated to following up on them is wasted.
ZirMed’s claim status monitoring technology solves both challenges. It enables your organization to work smarter by identifying claims that have issues so that your expert staff can follow up with them while leaving the rest to run their natural course.
Working the exceptions
Rather than requiring your staff to review every claim that appears to be past due, ZirMed’s claim status monitoring technology automatically monitors the status of your claims at the payer and sends automated claim status inquiries according to custom schedules that accommodate your specific payer follow-up workflow.
If the claim is still processing, the status is noted and your revenue cycle staff doesn’t have to touch it. Their time can then be applied to more productive tasks.
It’s only when the technology confirms that a claim has a pended status or some other exception that your staff gets involved. They’ll be notified of the issue (missing patient information, missing documentation, etc.) so that the right person can be assigned to take the proper action, ensuring that the claim finishes processing instead of aging to denial status.
This technology-driven approach also helps you avoid prioritizing claims by their dollar value and potentially following up on claims that don’t need it while ignoring others that do. You have the ability to work smarter and quickly see the results from a dollar perspective and through the time savings of increased efficiencies.
Less outsourcing required
ZirMed’s claim status monitoring technology helps you save money on outsourcing. Rather than turning over what appears to be past due claims to an outsourcer for follow-up (only to have them paid a few days later without any intervention), you’ll know exactly when specific claims require attention. The result is that you can keep more of that revenue for your own organization.
The advantage of accessing the source data
As you look into claim status monitoring solutions, it’s important to understand how they obtain data from payer systems.
ZirMed goes directly to payer systems, using electronic data interchange (EDI) to transfer the information from payer systems to ours. It is the fastest and most reliable form of data exchange.
Other solutions use a technology called “screen scraping,” which obtains the data from human-readable websites. The problem there is if a field moves or something else changes on the payer website, the screen scraper won’t work properly and it won’t be able to deliver data until it’s fixed. That could take a few hours, or even a few days. Either way, you won’t receive the information you need to follow up on claims.
Put your money where your money is
Devoting resources to randomly following up on claims to determine their status is inefficient and expensive. ZirMed’s claim status monitoring technology will give your efforts a laser-like focus, helping you to achieve the maximum ROI.
How has your organization approached claim status monitoring? What kind of success have you had? Do you feel like you’re on top of the issues, or are you constantly behind?