Posted By Fuller Harvey On December 18, 2017
Getting the bottom line healthy for any health-care related clinic or business is the business equivalent of the aorta to the human body: it is the life-line for health to abound for both patients and employees.
The overall health of a person’s body is keenly tied to blood successfully flowing through the aorta – the largest artery in the human body. Blood clots and blockages inhibit blood flow, and if blood “ain’t flowin’, LIFE ain’t happenin’.”
Likewise, when it comes to a healthy clinic, the truest indicator of a healthy “blood line” is a healthy bottom line: money to keep the clinic operational – alive and healthy. Critical to keeping the life-blood flowing for a clinic is making certain insurance claims are paid and not denied. Denials of payment are costly, and the equivalent of blood clots or blockages: they cost clerical and administrative time, and they cost anxiety to each party involved (not the least of which is the patient). The ultimate cost is loss of revenue to a clinic for services already rendered – and if money “ain’t flowin’, LIFE ain’t happenin’” for that clinic or practice. A healthy electronic health records (EHR) system can help keep the life-source (payments) flowing and make the insurance filing process efficient and productive.
Per insurance giant Blue Cross/ Blue Shield (BCBS), “Nobody is happy when an insurance claim is denied. The patient certainly isn’t happy, the doctor isn’t happy, and believe it or not, the insurance company isn’t exactly thrilled either.” In their blog entitled “The 5 Biggest Reasons for Headaches Over Claims – and How Your Can Avoid Them” : the NUMBER ONE reason health insurance claims are denied actually has absolutely nothing to do with benefits and coverage of the plan in question, or even with the service provided. “Lacking or Incorrect Information” leads the list of reasons cited by BCBS for the denial of claims.
Senseless and frustrating, the denial of a claim for lacking or incorrect information at least has a silver lining for a clinic which is utilizing a cloud-based EHR: each time a patient visits a clinic, contact information is easily updated in real time – and the subsequently generated claim from the billing department to the insurance company will easily incorporate the correct information. As well, a healthy EHR will have real time insurance eligibility verification, both PRIOR to services being rendered, DURING processing with “data scrubber” features to ensure all claims have correct data and information before being sent to the insurance company, and POST sending, to trigger “waterfall” claims for the filing of secondary insurance. For example, as a cloud-based system, Patagonia Health clients report they experience rejections “less than 0.4 percent of the time, increasing their departmental revenue.”
When the bottom line matters – and ask the director of ANY clinic, it always matters— a cloud-based EHR with full real-time technical support can make all the difference in an insurance claim being denied or being paid, and keeping the life-source (funding) flowing. No blood clots allowed!