Inadequate Staffing

One of the most obvious effects of overly lengthy processes is inadequate staffing. If an employee’s time is being stretched thin because they have to complete too many tasks at once, then they won’t be able to do their job as effectively as they could if they had enough staffing. If a single employee is responsible for cleaning the entire hospital, stocking the supply closets, and updating the inventory management system, they’ll inevitably fall behind on one of those tasks. At best, patients will notice a slight decrease in the cleanliness of their hospital rooms. At worst, they’ll be at risk for contracting an infection because the staff member didn’t have time to properly sanitize their rooms. If an employee whose job is to update the inventory management system also has to complete patient billing, then a patient’s paperwork might not be processed accurately. The same goes for medical records. If a single employee is responsible for inputting every detail from each patient’s chart, there’s a chance that tiny but vital details will be missed.

Duplicate Responsibilities

Yet another negative effect of lengthy processes is that they often result in redundant responsibilities. For example, if one department is responsible for scheduling patient appointments and another department is responsible for updating the online calendar, there’s a chance that both departments will input the same information. This can happen when multiple departments have overlapping responsibilities. For example, a department responsible for scheduling doctor appointments also schedules patient appointments, and a department responsible for updating the online calendar also maintains the departmental calendar. In these situations, it’s important to note the differences between the two types of calendars. A calendar used for scheduling appointments is often used for internal purposes only. On the other hand, a calendar used to update patient appointments is often used for external purposes, such as posting the appointments online for patients to view

Manual Tasks That Are Time-Consuming and Tedious

Depending on the type of industry a person works in, completing manual tasks might be a regular occurrence. However, many healthcare employees find themselves trapped in a never-ending cycle of manually entering data, reviewing charts, and more. Manual tasks that are time-consuming and tedious include manually entering data into several different systems, manually reviewing patient charts, manually taking inventory of supplies, and manually logging time. Manual data entry is often necessary when the process that feeds data into a system doesn’t work correctly. For example, an inventory management system might not recognize when a box of gauze is used up, so an employee must manually enter the information. When manually reviewing patient charts, an employee must read through each chart and manually record information. For example, they’ll need to check each chart and manually record the patient’s ID number, allergies, and any other pertinent information. When manually taking inventory of supplies, an employee must manually count each item in the supply closet. This includes manually counting each box, bag, and jar of each type of supply. When logging time manually, an employee must record how much time they spend on each task in the day. This is often done on paper, but some companies have moved to electronic logging systems (ELPs) to make the process easier.

Loss of Patient Data Accuracy

Accuracy is crucial when it comes to healthcare data. But, when a single employee has to manually enter information into several systems, there’s a higher chance of inaccuracies creeping in. This is especially true when that employee is responsible for entering information quickly and accurately. For example, an employee may incorrectly record a patient’s name, birth date, allergies, and other information when manually inputting data. This can happen when they’re rushing to enter data and don’t take the time to double-check each entry. When it comes to an employee manually entering data into several different systems, there’s a higher chance for inaccuracies. For example, the employee may incorrectly record a patient’s allergy information in one system, but correctly record it in another system. This data discrepancy can lead to the wrong type of treatment being administered during an emergency.

Waste From Discrepancies in Data

Healthcare providers often use data as a benchmark for patient care. For example, if one hospital’s patient-to-nurse ratio is 6:1, and another hospital’s patient-to-nurse ratio is 9:1, they’ll use that data to determine which is the better hospital. Unfortunately, when hospitals are using data that isn’t accurate, they’re just wasting time and money. For example, if two departments are inputting the same information into different systems, there’s a chance that the information will be inaccurate. When two departments are inputting the same information into different systems, there’s a chance that the information will be inaccurate. But, if two departments are inputting different information into the same system, there’s a chance that the data will be inaccurate. For example, if one department is responsible for manually entering data about a patient’s allergies and the other department is responsible for manually entering data about a patient’s allergies, there’s a chance that one department will incorrectly record the information and that the other department will correctly record it.

Constant Change is the Only Constant

A final negative effect of lengthy processes is that they often lead to constant change. This is especially true when an organization is adding new technology or switching up procedures. When an organization is undergoing constant change, it can be difficult for employees to keep up. For example, an organization might decide to implement an electronic medical record (EMR). Unfortunately, an employee may be uncomfortable using the new system or they may take longer to become familiar with it than the organization would like. This can lead to growing frustration on both sides. Additionally, an organization may decide to use a new software system for scheduling appointments. Unfortunately, an employee may be more comfortable with the old system. This can result in employees taking longer to manually input appointments and feeling less efficient than they did with the old system.

Conclusion

The healthcare industry is filled with lengthy processes that can negatively affect employees if they aren’t streamlined. It’s important for healthcare providers to work with their employees to improve processes and help employees become more efficient so they can spend less time on manual tasks and more time providing the best care possible.

Let’s Talk Results

The law’s main premise is that a payer must reply to a valid claim within a certain amount of time (usually around 30 days for electronic claims).

In order to efficiently use the clean claim rule, your medical billing process must have a tracking system that flags:

• Which insurance firms are covered by your state’s clean claim statute (some are exempt)?
• The date on which your clinic submits each medical claim for the first time;
• Events that bring the clean claim clock to a halt (e.g., an information request from the payer),
• When your practice has responded to payer requests by taking action;
• The date on which you received the final adjudication decision from the payer.

The prospect of carefully tracking all of this data may seem intimidating, but with the right system architecture, it is both achievable and desirable. Your claims will pay faster after you file a few Clean Claim law violation reports. I’ve witnessed cases when payers have contacted solely to reassure the practitioner that claims will be processed swiftly.

Running a trial on a payer that frequently takes more than 30 days to adjudicate claims is one method to quickly get started using the clean claim law. Find a small number of significant claims for this payer that have been open for more than 30 days and run a test with them. This will enable you to understand the foundations of how to file, monitor, and view the results of complaints.

Tips for Getting Your Medical Practice to Have a 95% Clean Claims Rate

How can your medical practice attain a clean claims rate of 95%? Despite the fact that this may appear to be a tall goal, there are several medical billing tactics your medical practice may apply to help increase your clean claims rate – and your entire revenue cycle management!

Keep patient records up to date.

There’s a lot of patient information that can change—and change quickly—from contact information to insurance carriers and more. Patients must check or update their current information before getting treatment, as faulty patient data is a leading source of denied claims. To reduce delays, use exact documentation to help check patient information ahead of time, and have patients update their paperwork at every visit (or even sooner with automated reminders).

Prior to the date of service, double-check your eligibility.

Patients that come to your office on a regular basis are known as established patients. They’re also the patients who your employees might presume haven’t had any recent insurance changes. Most denied claims, however, are generally the result of outdated established patient insurance information. Collecting and confirming every patient’s primary, secondary, and even tertiary insurance at least five days before their scheduled service is one step toward a 95 percent clean claims rate.

It’s also vital to double-check any in- or out-of-network benefits, copays, or deductibles.

Keep in mind the deadlines for filing insurance claims.

In most cases, filing a claim necessitates submitting it within a specific time frame. Any claim submitted outside of the window will result in a higher number of refused claims.

 If you want your practice to have a near-perfect clean claim ratio, one of the best ways to do so is to pay attention to claim deadlines and handle any concerns with patient coverage prior to their date of service so the claim is not submitted late. Aim for authorization between three and five days prior to service as a best practice.

Even the cleanest, most well-documented claim can often take weeks, if not months, to process. In the meantime, the practice loses out on revenue. This is why many of them opt to have their billing handled by a third party. Ultimately, WWS contributes to a smooth, continuous flow of revenue that benefits the bottom line of health practices. Contact WWS today to learn more.