Hayes' Healthcare Blog

The Impact of Rebilling Claims

Posted by Jewell Glover on October 28, 2013 at 7:30 AM

Claims can be delayed or interrupted at any place in its lifecycle. For many organizations, this is unnoticed – the claims fall into a ‘black hole.’ However, with quality controls and accurate reporting tools, this issue can be remedied. The impact of rebilling claims, such as duplicate denials or rejections, are typically are the root causes of increased cost and lost revenue.

Organizations with a complex payer mix such as Medicaid, Medicare, managed care and commercial can benefit from learning the denial matrix and cross-mapping used by each payer to avoid denials and duplications of claims. It is also advantageous for the A/R staff to be trained on the appropriateness of effectively rebilling claims, and the timeframe it takes to resolve them. Claims rejected by the clearing house are mailed to the address on the claim. If the address is incorrect, the claim is returned to the sender as undeliverable mail. Incorrect claim submissions, electronic or paper, is costly to an organization in such areas as claims, mailing/returned mail, and FTE working denial /reject backlogs. If a claim continues to be denied after several submissions, it can fall into the bucket of lost revenue due to missing filing deadlines.

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Topics: claims process improvement, decreasing claims denials, healthcare billing

The Benefits of Outsourcing Certain Business Office Functions

Posted by Grant Crossman on October 21, 2013 at 7:30 PM

Eight years ago, I was a typical business office director, borrowing staff from charge entry and giving them to the payment posting department to ensure that all payments were posted prior to the month end close. I was presented with an opportunity to gain additional staff at a lower cost without raising internal headcount, while maintaining a consistent quality and production metric. It was called outsourcing.

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Topics: business office, business office outsourcing, healthcare operations outsourcing

Clinical Optimization Example: Physicians’ Order Preference Lists

Posted by Anthony Odden on October 14, 2013 at 10:00 AM

During a recent clinical optimization engagement, one of the many optimization tasks we tackled in our weekly meetings was the physicians’ order preference list. The preference list makes ordering procedures and medications on common orders much easier. This list is hard to develop and finalize before the electronic medical record (EMR) system is live, but it is a very simple fix within the build. These fixes can usually be done within a week, but there are still a few steps to follow.

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Topics: clinical optimization, improving physician order process, emr optimization

Consolidating laboratory operations during a merger

Posted by Peter Levesque on October 7, 2013 at 7:30 PM

Mergers and acquisitions often necessitate the consolidation of lab operations on a common platform.  Several obstacles present themselves, including cultural dissimilarities, lab instruments used and testing methodology and reporting. The following are considerations that can help make the lab system build and implementation a success:

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Topics: healthcare mergers and acquisitions, lab operations, healthcare laboratory merger

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