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3 Ways to Achieve a Disjointed Claims Management Workflow

Posted by Sharon Chin on Jun 20, 2015 10:30:00 AM
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Disjointed_claims_management_workflowInefficiencies, denied claims, and inaccurate reimbursements. If those words excite you, then this post is just for you! 

If you like inefficiencies, managing several different processes to support your claim filing workflow is the way to go. A lot of practices use paper records in the beginning of the workflow and then a clearinghouse to manage their claims at the end of the workflow. Using a combination of both paper and electronic solutions exposes you to a high risk of inaccurate coding and denied claims. If that’s what you’re aiming for, keep reading!

To achieve a disjointed claims management workflow, you’ll need to have the following processes in your practice:

  •          Use of paper charts
  •          Manual claim filing
  •          Duplicate data entry between various systems

How to Achieve an Inefficient Claims Management Workflow

Paper Charts

Coding starts at the exam level, not billing. Doctors should use the right diagnosis codes during the exam when they make a diagnosis and document the condition and treatment. The coding process can be complicated, especially when it comes to medical coding. So unless you’ve memorized and know how to use all the insurance codes, a denied claim is just waiting to happen when you’re still using paper to document exams.

Filing Claims Manually

If you’re going to multiple payers’ sites to check for eligibility, you are probably doing the same to submit claims. Going to multiple sites means learning multiple systems, and keeping up with the complexities of each. Accessing all of the payer sites you may file to also means creating accounts on each one, for each employee in your practice. Your staff will also have to remember how to use each site’s varying functionality, and know how to train others to use them. It’s an inefficient use of time and resources - great for any practice with lots of time to kill.

Duplicate Data Entry

This can happen in several scenarios, such as using paper charts with electronic claim filing, or not integrating your clearinghouse and practice management system. Inaccurate coding occurs because manual processes are prone to human errors, especially when there’s multiple data entry between systems involved.

Looking for more ways to ruin your claims management workflow? Download our latest eBook, “8 Claim Filing Habits to Say Goodbye to in 2015.” But in this case, you could also use our eBook to look for 8 bad claim filing habits to adopt this year!

Download eBook!

Topics: Practice Management, Optometry eBooks, Biller

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