Claims Optimization


Enhancement of the revenue cycle relies upon many factors, several of which have been outlined in previous blogs. These factors include paying attention to optimizing the efficiency of the cycle itself, optimizing the quality of the claims that are sent out to payors, maintaining technologies that are efficient in producing meaningful data that translate your work into documentable services that can then be relayed clearly and accurately to payors, and enhancement of these technologies with additional help that improve quality of documentation and claims. All of these aspects help to ensure a successful and productive revenue cycle.

Here is a review of some key pointers for optimizing claims (and thus the revenue cycle) from previous blogs.


Use of scribes

The accuracy of claims begins with accurate documentation of a healthcare provider’s services for a particular care episode. Without clear documentation and accurate capture of medical events, this not only makes it difficult to coordinate care, but to come up with convincing claims that are thorough enough to achieve approval and ultimate payment from the payor. The use of medical scribes can enhance the quality of future claims by establishing an accurate record of medical services from which the billing personnel can work with to designate the proper codes necessary for a successful claim.


Real-time billing

To reduce medical errors and save time in back-log work that would result from seeing patients and documenting after the visit is over, real-time billing is becoming the new form of work-flow that enhances efficiency by on-the-spot documentation, immediate communication of patient services, and correct coding for the perfect, undeniable claim. In such a system in which the medical scribe communications directly with billing personnel, this takes care of two tasks at once (medical and financial) all while the data from patient examinations is still being accumulated. This reduces errors that can result when trying to recall information after a patient visit.


EHR enhancement

Optimization of your EHR as well as optimization of how you make use of your EHR is also essential for taking the accurate documentation from the medical scribe and making it useful to your work-flow (and revenue cycle). Structuring your EHR to fit your workflow will not only make the patient service process faster, but also the billing process. The interoperability of your particular EHR database system with other databases from organizations or healthcare providers with whom you work with should also be taken into consideration, particular for coordinated care episodes. This helps in getting everyone involved in the care process on the same plane with what has actually happened, what is the current condition of the patient, and what needs to be done next. This clarity within a health organization network is also a helpful check when it comes to claims. If various work-flows are all in alignment, the chances for a claim that is reasonable and subject to approval and payment is highly likely.

Michael Murphy, MD
Dr. Michael Murphy is co-founder and Chief Executive Officer of ScribeAmerica, LLC. He co-founded ScribeAmerica in 2004, and it is now the country’s largest and most successful medical scribe company with a staff exceeding 7200 employees operating in over 46 states nationwide. Today, ScribeAmerica is the recognized leader of the medical scribe industry and remains at the forefront of professional scribe education, training, and program management nationally. Dr. Murphy served as an Army Ranger for the 1st Ranger Battalion in Savannah, Georgia, which allowed him to gain various leadership skills along with the ability to develop standard operating procedures. He applies this to his daily duties for ScribeAmerica. Dr. Murphy has been a leader on multiple issues including scribe policy, hospital throughput, electronic medical record implementation and optimization of provider to patient ratios. His goals are to continue making all medical practice locations an environment built for an exceptional patient experience that allows providers to focus solely on patient care. Dr. Murphy received his Doctor of Medicine from St. George's University and completed his residency training in Emergency Medicine at the University of Medicine and Dentistry of New Jersey in Newark. He has co-authored one textbook and is involved in 3 peer review articles.
Posted In: Future of Healthcare, General, Quality, Efficiency, Utilization On: Tuesday, 15 August, 2017

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