Top 5 Mistakes in Claims Management – And How to Avoid Them
Claims management accuracy and efficiency are crucial for hospital billing, accounting and finance professionals. However, common missteps can cause...
Navigating reimbursements for the Medicare program has been a long-standing challenge for many providers. With the government reimbursement landscape constantly shifting due to policy changes, complex regulations and nuances related to patient coverage, maintaining a steady revenue stream can feel like walking a tightrope.
Specifically, it’s important to be proactive in managing any Medicare Bad Debt since there is still opportunity to be reimbursed for a portion of any amount unpaid by a patient. Currently, Medicare reimburses providers 65% of unpaid and uncollectible Medicare beneficiary cost-sharing amounts, which includes both coinsurance and deductible.
Let’s explore the four major challenges faced by hospitals for claiming Medicare Bad Debt reimbursement and potential solutions to overcome them.
1. Lack of Expertise and Internal Resources
For hospitals, the ability to accurately identify claims eligible for Medicare Bad Debt reimbursement requires specific expertise and dedicated resources. Unfortunately, many healthcare facilities lack the staffing and knowledge needed to navigate the intricacies of processes and reporting Medicare Bad Debts which is part of the Hospital and Health Care Complex Cost Report. As a result, many may miss out on recouping additional dollars to maintain a healthy bottom line.
For example, one difficulty encountered by hospitals is understanding the difference between allowable and unallowable bad debt. This distinction greatly impacts the reimbursement they receive. Reimbursement teams must meticulously analyze patient data and claims to maintain compliance with CMS regulations.
What can be done: To address this challenge, hospitals can partner with third parties who have the necessary experience and technology to streamline the reimbursement process and complete portions of annual cost reports. Outsourcing for consulting services is beneficial when staffing is a challenge, and a knowledge gap exists. This can be a budget-friendly option compared to purchasing new technology or even hiring additional staff.
2. Complex Rules
Navigating the complex rules and regulations surrounding Medicare Bad Debt reimbursement only adds stress for providers. These regulations set by CMS are subject to change, and healthcare organizations must stay up to date to avoid costly errors.
For example, Transmittal 18 now requires a new Exhibit 2A for Medicare Bad Debts effective for cost reporting periods beginning on or after 10/01/2022.
What can be done: To mitigate this, hospitals can set up robust internal processes, including regular audits and training programs, to maintain compliance. Additionally, working closely with industry experts and third parties can ensure your team stays updated on the ever-changing landscape of reimbursement rules.
3. Lack of Automation
Technological advancements in healthcare are revolutionizing revenue cycle management. However, some hospitals lag in adopting these innovations, particularly when it comes to automating Medicare Bad Debt processes.
What can be done: Implementing automated systems can enhance accuracy and efficiency while simplifying the complex process of handling data related to Medicare Bad Debt. Look for technology solutions that can identify available Medicare Bad Debt and provide actionable analytics and summary reports.
Whether you choose to outsource reimbursement projects or implement in-house software solutions, it's essential to leverage advanced technology with intelligent algorithms to maximize efficiency, effectively optimizing both time and budget resources.
In fact, many healthcare finance leaders are already prioritizing a more digital approach. According to FinThrive’s 2023 RCM Transformative Trends Report, 80% of providers consider RCM technology investments a top-five priority this year.
4. Data Intake and Human Error Issues:
Mistakes made during data intake puts RCM teams at risk of data inaccuracies for Medicare Bad Debt reimbursement. Even minor errors can lead to missed opportunities for revenue recovery or potential compliance issues.
What can be done: Hospitals should focus on improving data collection processes and implement rigorous quality control measures. By ensuring data accuracy and conducting regular audits, hospitals can minimize the risk of errors and maximize reimbursement potential. Third-party consulting services that utilize advanced software can also solve inefficiencies and boost accurate reporting.
Accurately identifying Medicare Bad Debt represents a significant revenue opportunity for hospitals. By recognizing the hurdles and implementing appropriate solutions, such as partnering with a third party, hospitals can optimize their reimbursement outcomes.
Interested in learning more about how your team can better manage government reimbursements? Read our guide that details how to get the most out of your Medicare and Medicaid reimbursements.
