A lot of claims being worked everyday. A lot of errors from the front end. A lot X type of payer denial. A lot of appeals in the works.
A lot, a lot, a lot.
We had an edifying pow-wow with Jim Knight, CEO of ACU-Serve this week, incredible that we found a moment in what feels like #EvenMoreMeetingsOctober. We got into conversation about data. Jim posed the question to our team, "On average how many reasons/justifications would a billing specialist who is working an average book of AR give for why a CO16- Claim Lacks Info denial was received? Would it be over 12 or under 12?" Our seasoned billing veterans in the crowd smiled.
CO16 and nearly sixteen outcomes to explain what lead to this profit killer. What's the solution? Data. Data is King (or Queen). Raw data is the start, but having quantifiable data that can be easily observed is where the rubber meets the road.
Higher clean claim rates, contract enforcement, and profits will only grow when we can see the problems and strike in an efficient and exacting manner. Your billing specialists can look forward to and end to doing work they feel shouldn't have come to them in the first place, due to gaps in the front end that create claim deficiencies. Your Billing Managers will love that they can see exactly how good or bad a specialist is at resolving the root cause, and that they have a blueprint for intervention & training.
Your Billing Specialists are doing a lot, but maybe they don't need to be.
-by Lisa Anderson