Claims management accuracy and efficiency are crucial for hospital billing, accounting and finance professionals. However, common missteps can cause expensive delays, denials and reimbursement deficiencies. Below, we explore the top five mistakes in claims management and offer insights on how to avoid them.
1. Inaccurate or Incomplete Data Entry
Errors in patient data, coding or billing information are among the leading causes of claim denials. Whether it’s a typo in the patient’s information, incorrect coding or missing documentation, even small mistakes can lead to significant delays in payment.
How to Avoid It
Implement a thorough review process for all claims before submission. Leverage automated tools, like FinThrive’s Claims Manager, that flag errors in real-time, allowing your team to correct issues before they lead to a denial.
RELATED: Claims Management Buyer’s Guide
2. Failure to Stay Updated with Coding Changes
Healthcare billing and coding regulations evolve frequently. Changes in ICD-10 codes or updates to payer requirements can render a claim invalid if your system isn’t updated accordingly.
How to Avoid It
Ensure that your billing software is updated regularly and that your staff receives ongoing training on the latest coding standards. Using a claims management system with built-in regulatory updates ensures that you are always in compliance with the latest standards. Finding a vendor that will partner alongside you in educating staff can be valuable, too.
3. Lack of Payer-Specific Knowledge
Not all payers follow the same guidelines. Failing to understand the unique requirements of each payer can result in denials, resubmissions and delays in reimbursement.
How to Avoid It
Develop payer-specific workflows within your claims management system. FinThrive’s Claims Manager helps create customized rules for different payers, allowing your team to meet each payer’s requirements accurately and efficiently.
RELATED: Improving Payer-Provider Collaboration
4. Ignoring Denied Claims
Many healthcare organizations focus heavily on initial claim submissions, but neglect denied claims, allowing valuable revenue to slip through the cracks. Denied claims that go unaddressed are lost opportunities for reimbursement.
How to Avoid It
Establish a dedicated process for managing denied claims. Implement a tracking system to ensure all denials are reviewed, corrected and resubmitted promptly. FinThrive’s Claims Manager offers advanced denial management features, enabling hospitals to track, investigate and recover denied claims efficiently.
5. Underestimating the Value of Automation
Many hospitals rely on manual processes for claims management, which increases the risk of human error and slows down operations. Relying on outdated methods can result in backlogs, missed deadlines and ultimately, delayed revenue.
How to Avoid It
Embrace automation. Modern claims management systems streamline the entire process—from data entry to claim submission and denial management—allowing for faster, more accurate claims processing and higher reimbursement rates.
Optimize Your Claims Management Process with FinThrive
Mistakes in claims management can severely impact your hospital’s cash flow and revenue. By recognizing and addressing these common errors, hospitals can significantly reduce claim denials, speed up reimbursements and improve overall financial health.
Is your hospital making any of these claims management mistakes? Explore how FinThrive’s Claims Manager can help you streamline processes, avoid costly errors and ensure smooth, continuous claims processing.
