Make Your Claims Management Procedures Healthier

Medical claims are an important part of the hospital record-keeping puzzle.


Without the proper claims procedures in place, billing and filing can quickly become a nightmare.

In order to help keep your hospital on the right track, here are a few ways to make sure your claims management system is as healthy as possible:

Cost of Claims Errors

The medical claims process is a delicate one. There are a number of elements that come into play when deciding patient billing, which can often result in claims errors.

In fact, according to the latest report by the American Medical Association, almost 20% of commercial health insurance claims result in processing errors.

These claims processing errors cost insurers and hospitals more than $3.5 million in unnecessary charges each year.

Add to that the administrative costs that go along with each claim and processing errors end up costing the health system more than $1 billion every year.

If your hospital wants to avoid statistics like these, then it needs to improve its claims management procedures. Fortunately, there are a number of steps your hospital can take to do exactly that.

As the article “Healthcare Revenue Cycle Management: Streamlining Claims Management” looks at, a growing need among hospitals all across the country is healthcare revenue cycle management (RCM).

With the proper RCM procedures in place, hospitals can reduce Medicare and health insurance denial claims and increase overall reimbursement. RCM management also reduces the amount of paperwork that goes into the medical claims process.

Medical claims management and RCM go hand-in-hand and when both procedures work seamlessly together, it improves workflow.

Billing Accuracy

After a patient is treated, the services your hospital rendered are coded and sent off to the appropriate health insurance agencies to determine coverage. This is when most medical claims errors take place, especially when Medicare and other specific insurance providers come into play.

By using RCM, your hospital can avoid any claims errors by streamlining the claims process. From electronic processing to contract denial management, RCM immediately find claims errors and remedies them before they turn into a costly mistake.

Improved Record-Keeping

Your hospital’s records department handles hundreds of patient billing records every day.

On top of that, they’re also in charge of collecting and storing patient information on a daily basis. Medical claims management is a necessity in this type of file-heavy environment.

The proper claims management procedures in combination with RCM can help your records department keep track of the treatments and expenses that go along with each visit. In addition, RCM can handle complicated health insurance policies, even if the patient visits more than one medical facility for treatment.

Claims Management Options

There are a number of ways you can implement healthier claims management procedures into your hospital. A number of companies offer claims management and RCM software that’s user friendly as well as easy to install.

However, most medical facilities in the country opt for outsourcing their RCM and medical claims management.

Claims management service providers are able to handle large amounts of patient claim information quickly and accurately. In addition, outsourcing claims saves money on training in-house employees.

When your hospital is ready for healthier claims management procedures, the information above will help you get started on the right track.

About the Author: Adam Groff is a freelance writer and creator of content. He writes on a variety of topics including healthcare and technology.