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Hospital Claims Management

By 31 March 2024April 29th, 2024No Comments
hospital claims management communication

How to Develop a Robust and Effective Claims Management System?

Are you tired of manually handling patient claims and reimbursements? Now is the time to automate your claims management tasks to save costs and speed up your revenue cycle.

hospital claims management communication

With claims denial rates ranging from 1% to 57%, healthcare providers need to employ more efficient processing methods. They must submit error-free claims in a timely manner to reduce overdue balance accounts. Also, they should take care of other things related to hospital claims management, like effective patient interactions and transparent billing.

However, it can be daunting for hospitals and physician practices to verify claims, check medical records, file accurate reports, connect with the insurer, etc. There is only one way to streamline these tasks and develop a solid claims management system- digitalization.

You can automate all claims-related tasks and save a lot of time, effort, and money. This way, you can also manage denials quickly, follow up effectively, and receive timely payments.

Today's article will discuss the benefits of automating claims processing for your institution. Let's dive in!

What is Claims Management in Healthcare?

Claims management in the healthcare industry means billing, organization, filing, processing, and submitting patients’ medical claims. It is related to the patients’ diagnosis, medications, and treatments.

Hospitals and other healthcare organizations must submit claims to their patients’ health insurers. But, how are hospitals reimbursed for their services and care?

Basically, the insurance agencies review the claims submitted by healthcare providers and decide whether to approve or deny the same. If approved, you receive the reimbursement for the medical services given to the insured patients. The balance is paid by the patients themselves at the time of service.

However, if your claim is denied, you need to re-submit the claim after making the necessary modifications. Naturally, it is a lengthy, hectic, and expensive process.

Thus, most institutions or practices outsource these jobs to claims management services. These services can help them in everything from drafting precise claims to handling all related correspondence.

Hospital claims management is not a one-time task; it is an ongoing process that needs robust strategies. But, often, there is a big gap between these strategies and the execution procedure. An efficient automation API or software can help you bridge this gap and finish your tasks smoothly.

Why Do You Need an Efficient Claims Management System?

There are several reasons why you should automate or digitalize your claims processing activities. Apart from saving time and increasing efficiency, you can avail of various benefits, such as:

Preparing and Submitting Clean Claims the First Time

Many healthcare providers deal with undercharges and other issues because of submitting inaccurate, incorrect claims. But proper claims management can result in:

  • Identifying errors before submitting claims to the clearinghouse
  • Doing away with time-consuming and expensive rework
  • Boosting reimbursement rates by getting your claims approved the first time
  • Reducing account receivable (A/R) and improving cash flow

Prioritizing High-Ticket Accounts

A productive claims management process helps you prioritize high-impact claims and increase revenue. You can view your patients’ insurance eligibility, payer compliance, demographics, etc., and segment claims accordingly. Thus, your team would know which accounts to focus on more. 

Such segmentation also helps you personalize communications, offer improved customer support, and channel your efforts toward smooth claims management healthcare.

Improving Data Quality

A claims management software can help you collect high-quality data related to all aspects of your patient-provider relationships, like:

  • Pre-registration
  • Patient care and treatment process
  • Clinical documentation
  • Billing- collections, patient support, follow-up, etc.
  • Administrative services- managed care contracts, debt collections, fee schedules, etc.

Thus, claims management helps you access accurate and helpful information allowing you to prepare claims without confusion. It helps you keep up to the industry standards, compare your processes with competitors, and improve your overall reimbursement strategies.

The better your strategies are, the higher your chances of getting paid by the insurers faster. Therefore, it is crucial to automate your activities and reduce paper-based transactions.

Monitor Your Claim Statuses 

Employing an efficient claims management healthcare system makes it possible to keep tabs on your claim statuses. It enables you to spot any issues in the process immediately and solve them in an automated way, saving time and speeding up payments.

You no longer need to follow up with insurance agencies or clearinghouses manually. Insurance claims management can help you automatically respond to insurers and improve productivity. Also, it allows you to send triggered debt collection letters and emails to them from time to time.

Managing Denials

Returned, denied, and pending claims are a huge problem for healthcare institutions. However, claims management resources help you deal with such claims and make the required changes.

If done manually, a hospital needs to have a separate denials management department as it is a never-ending issue. It can often be disappointing and daunting to deal with suspends, zero pay, and denials. Thus, it is advisable to deploy claims management at the earliest and reduce the number of denied claims in your system.

Identifying Trends

Another thing that claims management services help you with is identifying the reasons for denied claims. By knowing the root cause of such problems, you can develop better processing methods and avoid these issues right from the beginning.

Analyzing and Reporting

You can effortlessly analyze your patients’ long-term needs, insurance coverage, healthcare plans, etc., by managing claims digitally. This way, you can view timely reports anytime you want and have the data at your fingertips for completing all the claims-related tasks speedily.

What Steps Can You Take to Improve Your Claims Management Process?

Apart from automating your tasks, there are some other things you can do to improve your claims management plans, including: 

Share Responsibilities Equally Between Frontend and Backend Staff

Firstly, let us understand what the frontend and backend staff are responsible for. The frontend workers complete jobs, like:

  • Capturing coverage data
  • Verifying the details and checking eligibility
  • Obtaining referrals and conducting prior authorizations
  • Collecting deductibles at the time of patient care

If you want your claims management healthcare to proceed, consider hiring fee billing professionals and training them properly.

Coming to the backend responsibilities, they consist of tasks, like:

  • Tracking and solving billing edits. 
  • Following up on A/R accounts
  • Posting denials
  • Providing feedback to the frontend staff
  • Submitting timely claims, etc.

Both of them work hand-in-hand. But, most problems are identified and resolved later by the backend. By adopting a shared responsibility approach for claims management, you can fix these issues way before and improve efficiency.  

Contact Insurers in Multiple Ways

It is not enough to drop an email once in a while to inquire about your A/R. Try connecting with the insurance companies or other payers more often and via multiple channels to facilitate incoming payments.

Hospital claims management helps you send offline letters and emails asking insurers to complete reimbursements on time. You can use PostGrid’s direct mail services to mail letters automatedly and at affordable rates—increasing responses and reimbursement rates. 

Update Patients Regularly

It is not mandatory but advisable to keep in touch with your patients regarding their health insurance claims. This practice helps you deepen personal bonds with patients and acts as an excellent marketing strategy.

A claims management company allows you to update patients with their claim statuses. You can further personalize these communications to improve patient assistance.

Develop Relevant Performance Metrics

Try developing industry-relevant performance metrics to track your financial performance. It helps you get precise insights into your A/R and incoming payments.

Thus, healthcare providers can make the required changes to their claims management process and persuade insurers to cooperate with them efficiently. 

You should also upgrade your claims management resources frequently so that you can employ the latest technologies and stay ahead of the competition. 

Protect Your Patients’ Data Privacy

Prioritizing patient data privacy is significant for healthcare providers. The healthcare industry is strictly regulated by HIPAA, PIPEDA, and other such laws. Thus, take care to only share the required information with insurers only. Not only is it legally necessary, but it also shows that you are a reliable and trustworthy institution.

While outsourcing claims management, ensure that the software provider is safe and compliant. For example, PostGrid’s direct mail API complies with all data protection laws like SOC-2, GDPR, HIPAA, and PIPEDA. Therefore, you can create, print, and send letters with PostGrid securely and confidentially.

How Can PostGrid Help Healthcare Institutions With Claims Management?

PostGrid’s automated direct mail solutions can help physicians and hospitals handle claims processing. Here’s how:

Patient Statement Printing and Mailing

PostGrid makes patient statement printing and mailing a breeze. You can integrate our print and mail API into your CRM and start sending out statements in just a few minutes.

Thus, you can start your claims management process with ease by storing accurate details of patient accounts—helpful in preparing claims. PostGrid allows you to draft precise patient statements that you can print and distribute simultaneously.

This way, you can capture data and update patients altogether, saving administrative costs. You may also add customizations to your statements, such as your brand vision and logo.

Apart from sending statements to patients, PostGrid also enables you to send them to insurers for claims management. You don’t need to worry about printing and logistics; just make a few clicks and start mailing.

Sending Bills to Insurance Companies

Along with timely statements, you may also need to send bills or invoices to insurers. You can send them along with claims or separately, depending on your interactions with them. 

PostGrid offers several invoice templates to help you draft invoices for claims management healthcare. You can select one as per your needs and add the required customizations. Also, the API lets you pull details from your CRM in no time to draft accurate invoices without any manual effort. 

Related: Invoice and Payment Letter Templates

Preparing Other Medical Documents

Claims management needs real-time effort wherein you constantly interact with third parties and respond to their queries. Thus, you require a dependable and seamless direct mail API like PostGrid to help you send documents to insurers as the need arises. Our 2-business day SLA makes this activity fast and easy for healthcare providers.  

PostGrid helps the healthcare industry prepare and send all types of medical documents for insurance claims management, like:

  • Diagnostic test results
  • Explanation of Coverage (EOC)
  • Patient notices
  • Health status records
  • Explanation of Benefits (EOB)
  • Discharge summary
  • Operative reports
  • Assent and consent documents
  • Patient care forms and documents, etc.

Updating Patients’ Database

It is common for people to move to a different location and change their mailing address. The USPS got nearly 20 million address change requests in 2020 alone. Thus, you may need to update your database regularly for smooth hospital claims management.

Submitting claims with outdated patient information can lead to denials. You may have to re-draft and re-submit everything, taking hours of your time and effort. Also, it can cost you a lot of money unnecessarily. 

Hence, PostGrid helps healthcare providers verify their patients’ addresses effortlessly. You can run address checks for thousands of records in your database altogether. Our services are scalable and can handle millions of API requests—backing up your claims management process

You can also standardize the mailing addresses of third parties to ensure that you send out documents to the right people. This way, you don’t have to deal with lost mail, returns, data breaches, etc.

Securing Patients’ Personal Information

As said earlier, you need to secure your patient’s information to comply with HIPAA. Claims management requires you to exchange a lot of data to and fro insurers. Any data breach can cost you millions of dollars and tarnish your reputation. Thus, it would help to be careful and do everything according to the HIPAA regulations.

Related: Best Practices for Healthcare Institutions

PostGrid always prioritizes client data security and confidentiality over other things. Our API and software are HIPAA-compliant and in-built to protect your information. Hence, you can print and distribute claims management hospital letters without any issues.

You may also change your user permissions and regulate which staff members can access patient data. 

Sending Debt Collection Letters to Reduce Accounts Receivable

Sometimes, it is essential to send payment collection letters to get insurers to pay heed to your reimbursements. Claims management is about recovering the costs for your services from payers systematically. And yet, some insurers may delay payments due to several reasons. 

At this point, you may send emails for debt recovery. But, it is more effective to send letters to grab the insurer’s attention and convince them to settle your dues. It is a more personal correspondence form and generates more responses facilitating hospital claims management for you. 

Quick read: PostGrid and HubSpot Integration

Managing Letter Templates

PostGrid’s direct mail API allows you to manage your letter and invoice templates. Thus, you can pull out and use any template you need in seconds. It makes it very easy for you to draft letters related to your claims management system and reuse them as needed. 

Other than such transactional mail templates, PostGrid also offers postcard templates to help you connect with patients for various purposes. You can send appointment reminders, marketing, and appreciation postcards to show patients you value them.

Also read: Transactional Mail Printing

Workflow Tracking and Reporting

PostGrid facilitates claims management reporting and tracking for healthcare institutions. You can log in to your PostGrid account at any time and navigate your customizable dashboard to check report statuses. 

You may also send triggered letters to insurers for timely follow-ups to get paid quickly. PostGrid enables you to track your mail items, access periodic analytics, and plan your future mailing accordingly. Hence, you can create a more sophisticated and productive hospital claims management system

There are several other notable features that PostGrid provides, including:

You may also be interested in An Introduction Into Bulk Mailing Services

Thus, you can conduct smooth claims management and other related tasks using PostGrid at the most affordable prices. 

To Summarize

Now that you understand what is claims management in healthcare, we hope you develop a robust system to fulfill your operations in the best way possible. By employing the steps mentioned in this blog and using excellent claims management software, you can streamline your tasks and save hundreds of dollars. 

Such software applications help healthcare providers clear their reimbursements within a specified period. They allow hospitals and clinics to prepare error-free claims that can be approved by the payers the very first time. 

PostGrid’s direct mail API can offer great help in your claims management process. It assists you in printing and mailing medical documents to the right people at the right time. 

To learn more about how you can improve your claims management activities with PostGrid, talk to our sales team now!

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