How Healthcare Billing Departments Can Maximize AR Potential Before Year-End
December 10, 2024
Author: SSI Solutions Team
In a landscape driven by digital transformation, the fundamentals of claims management continue to prove essential. Revenue cycle leaders face mounting challenges: razor-thin margins, workforce shortages, and an increasingly complex claims landscape as payers delay processing and denial rates climb. Here are essential, actionable steps to shore up AR before year-end, grounded in insights from The SSI Group’s extensive claims processing experience.
Denial Trends in 2023
By the end of 2024, healthcare billing departments are seeing rising denial rates as payers increasingly delay payments, adding around seven additional processing days. Medicaid denials remain exceptionally high, consistently flagging registration errors and eligibility issues. Addressing these front-end issues can immediately boost revenue flow.
SSI Pro Tip #1: Identify high-denial payers with the longest response times and target these with refined workflows to secure faster payments. SSI Denial Management can help with incorporating follow-up and timely appeal filing deadlines into workflow.
Preventing Front-End Denials
According to recent SSI data, nearly 45% of denials are preventable but stem from errors at the initial registration phase. In 2024, staff shortages in revenue cycle roles have exacerbated this trend, making effective eligibility verification crucial. For example, SSI’s Pre-Billing Eligibility (PBE) solution performs a final eligibility check before submission, helping hospitals cut pre-registration denials by 67% and fast-tracking AR days by 6-10 days.
SSI Pro Tip #2: Implement robust eligibility checks through SSI Pre Billing Edits (PBE) to prevent costly eligibility-related denials and speed up AR.
Streamlining Claim Edits
In the push for efficiency, healthcare organizations can reduce redundancies by examining their claim editing processes. Eliminating duplicate edits between claim scrubbers and Health Information Systems (HIS) reduces administrative load and optimizes staff time. Moreover, prioritizing frequent or quickly resolved edits often yields quick wins for improved AR performance.
SSI Pro Tip #3: Boost efficiency by addressing and eliminating redundant claim edits. SSI Billing Edits allow health systems to protect against missed billing opportunities by running claims through an extensive edit suite to ensure claim compliance upon initial submission
Moving to Electronic Attachments
A significant 32% of claims require documentation attachments, and 73% are still processed manually, creating inefficiencies and delays. Switching to electronic attachments can save providers millions in operational costs while reducing claim processing time by up to two weeks. Electronic submissions offer tailored payer-specific edits that reduce denial risk.
SSI Pro Tip #4: To prevent costly, time-intensive denials, submit documentation electronically. SSI offers a streamlined and unified approach to managing electronic attachments, eliminating silos
Leveraging Data Analytics for Insight-Driven Decisions
SSI Claims Analytics empowers revenue cycle teams with actionable data to forecast cash flow and track KPIs in real time. With advanced analytics, organizations can strategically address bottlenecks and optimize performance benchmarks across different payer behaviors, payment times, and overall claim processing efficiency.
SSI Pro Tip #5: Use SSI Claims Analytics for in-depth payer behavior analysis to improve strategic revenue cycle decisions.
Keep an eye out for missing remits
Remittance management is an industry issue: payers have inconsistent processes to deliver remits back to a clearinghouse and provider. Missing remits can delay month-end reporting and cause extra work to resolve.
SSI Remit Tracker, included in Claims Director, provides visibility into all missing remit requests and significantly reduces the time needed to locate them. The tool includes a dashboard displaying all data on open and closed requests, including associated dollar amounts.
SSI Pro Tip #6: Use Find missing remits faster. Use SSI Remit Tracker to simplify and streamline the process of logging missing remit requests.
Conclusion
As 2024 winds down, healthcare billing departments face critical choices that impact AR success. Organizations can reclaim potential revenue by refocusing on core best practices—strengthening eligibility verifications, streamlining claims submissions, and embracing digital documentation.
The SSI Group’s time-tested solutions offer an optimized, data-driven approach for revenue cycle leaders prepared to secure their financial footing.
Contact SSI to begin the journey for a tailored approach to your revenue cycle strategy.
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