The healthcare industry is complex and always changing. With so many priorities and areas of business that hospitals and providers need to balance, it can be easy to miss areas of revenue leakage. One area, in particular, can lead to significant revenue leakage: denials management in healthcare. 

Due to its impact on revenue, denials management should be at the forefront of leaders’ minds. There are many ways that providers can properly implement denials management and many systems that providers can take advantage of to streamline the process. We’ll be covering how denied claims result in revenue leakage, some of the most common reasons the claims may be denied, and how to prevent denials in the first place.

Denials Contributing to Revenue Leakage  

With so many current issues in healthcare including wage inflation, rising costs, and worker shortages, providers are experiencing an enormous amount of pressure to focus on the top and bottom lines. Providers are closely inspecting where revenue leakage may be happening and deciding how best to solve the issue in order to increase savings. Automated denials management is a great place to start.

The average denials rate is between 6 and 13% with some hospitals reporting more than 20%. It can cost $25-118 to rework one claim, resulting in less profit. At the same time, 60% of the claims denied are not being re-submitted, resulting in lost profit. Improper denials management in healthcare can cost providers millions. 

Common Reasons for Denied Claims

The best way to manage denials is to prevent them in the first place. Many claims are denied for completely avoidable reasons. With this in mind, it will be useful for you and your team to know the common reasons claims are denied.

Missing or Incorrect Information

Claims can be denied for a simple reason such as a blank field. Each claim needs to be completely filled out and accurate. The information that's missing or incorrect could be regarding the patient's health records, the patient's personal information or demographic information. Automation is the best way to do this as it can inspect the claim, flag any missing or incorrect information, and make suggestions.

The Procedure was not Covered by Payer

Prior to any procedure, the administrative team should be reviewing a patient's plan and receiving authorization. Without doing this, the administrative team may be submitting a claim that’s certain to be denied. 

The Provider was Out of Network

This is very similar to the reason listed above, if the healthcare team reviewed the patient's plan or received authorization, this should not be an issue. However, if the provider is out of network, the payer may deny all or part of the claim.

Late Submissions

Many payers often have deadlines for claims that providers need to meet. These deadlines are usually a certain number of days after the treatment or service occurred. Sometimes the deadlines can also include any time it takes to have to rework rejections so it's important for claims to be submitted in a timely manner. Automation can also help with this by alerting team members to any approaching deadlines.

Duplicate Claims

Due to human error, claims may be submitted more than once resulting in one or both claims being denied and creating confusion as to whether the claim needs to be reworked or discarded.
 

Preventing Denials From the Start 

Many providers understand the importance of denials management in healthcare and have systems in place to help their team with the process. However, current approaches often use multiple systems that create confusion and can slow down the denials management process specifically when it comes to edits.

Exela’s automated denials management solution uses a single platform to streamline the entire denials management process. Our solution takes a denials avoidance approach, helping providers submit clean claims from the very beginning. 

Prior to submission, our PCH Global platform identifies and flags certain-to-deny claims by using its edit engines to assess each claim for Payer-specific edits, SNIP edits, Billing & Coding edits and Compliance edits. Where once providers would need to use multiple systems to look at different edits, PCH Global provides a single platform that addresses each of these edits, streamlining the process and improving turnaround time.

If a claim is suspended or denied, Exela’s denials management solution provides root cause analysis (RCA) which spots trends in the denied claim and alerts you to them. This can prevent the same issues from reoccurring, thus reducing the number of denials in the long term. With dashboard reports and analytic tools, you can identify existing areas of revenue leakage, find new ways to increase savings and experience more visibility into the denials management process resulting in more informed decisions moving forward.

Automate Denials Management in Healthcare

Denials management in healthcare can be simpler, standardized, and streamlined. Given how much revenue leakage can happen due to unoptimized processes, it's time for a more robust solution where providers can focus on the top and bottom line. With our focus on denials avoidance, Exela’s denials management solution brings providers what they need, streamlining the denials management process into a single solution while improving denials rates over time. 

Learn more about what Exela’s denials management solution can do for you.

Claim denials can pose a significant financial burden for healthcare providers, regardless of their size. However, avoiding claim denials is challenging; therefore, having a comprehensive plan and proactive approach is crucial.

What is Claim Denial? 

When patients receive healthcare services, third-party payers such as insurance companies or governmental programs cover some or all of the bill's costs. The healthcare provider submits a claim to the payer during the medical billing process, which may be accepted, paid, rejected, or denied. Visit our blog to understand healthcare automation tools that improve denial management.

Rejections occur when errors are identified during the early processing stages, whereas denials happen after claims have been processed. As a result, denials can be particularly challenging to manage, which is why claim denial management is essential.

Claim denials can have a significant impact on healthcare practices and providers, including:

• Financial losses: Denied claims result in lost revenue and may cause cash flow problems for healthcare providers.
• Increased costs: Resubmitting denied claims and appealing them can be time consuming and expensive, leading to higher operational costs.
• Administrative burden: Managing denied claims can be complex and requires additional administrative resources, which may detract from patient care activities.
• Reduced productivity: Healthcare providers may need to divert resources from other areas to address denied claims, resulting in reduced productivity.
• Patient experience: Denied claims can cause delays in payment and additional billing, leading to patient dissatisfaction and negative reviews. This can have a long-term impact on healthcare providers. 
• Compliance risks: Failing to manage claim denials effectively can lead to compliance risks, such as regulatory penalties and reputational damage.

Overall, claim denials can significantly impact the financial health and operations of healthcare practices and providers, making it crucial to have a proactive approach towards denials management. A denials management service with Exela’s PCH Global can improve cash flow, reduce denial rates, and more.

Understanding Denial Management

Denial management refers to identifying, analyzing, and resolving claims denials in the healthcare industry. A denied claim is a claim that has been submitted to an insurance company or government payer but is not paid because it does not meet the criteria for coverage or contains errors or omissions.

Denial management involves a systematic approach to identifying the reasons for denied claims, rectifying any errors or issues, and resubmitting them to the payer. It may also include appealing denied claims that are eligible for reconsideration. Effective denial management helps healthcare providers to maximize revenue, reduce operational costs, and improve patient satisfaction. In addition, by analyzing and addressing the root causes of denied claims, offering a comprehensive denial management approach that can identify areas for process improvement and implement strategies to prevent future denials.

Healthcare providers can take a proactive approach to denial management by implementing the following strategies:

• Identify common denial reasons: Healthcare providers should analyze denied claims to identify the most common reasons for denials. This can help them develop targeted strategies to prevent future denials.
• Educating staff on denial management: Healthcare providers should educate their staff on the importance of denial management and provide training on best practices for preventing and resolving claim denials.
• Use technology to streamline processes: Solutions like electronic health records (EHRs) and denials management software can help streamline the claims process and reduce the likelihood of errors and denials.
• Conduct regular audits: Regular audits of claims processes can help identify areas for improvement and ensure compliance with regulations. Effective denials management solutions such as PCH Global also analyze and track trends from collected data. 
• Develop a denial management plan: Healthcare providers should develop a comprehensive plan for managing denials, including strategies for prevention, identification, and resolution.
• Monitor payer policies: Healthcare providers should stay up-to-date on changes to payer policies and requirements to ensure claims are submitted correctly.
• Engage with payers: Healthcare providers should establish relationships with payers, communicate regularly to understand their policies and requirements, and promptly address any issues.

Denials Management with Exela PCH Global

Overall, denial management is an important part of revenue cycle management in healthcare. PCH Global offers solutions that ensure claims are paid promptly and accurately, enabling providers to deliver high-quality care to patients. The proprietary PCH Global platform identifies to-be-denied claims before submission. Exela's solution also analyzes suspended or denied claims using root cause analysis (RCA) to avoid recurring issues with claims. 

Exela’s denials management solution automatically categorizes based on the reason and remark codes, enabling a more thorough analysis. The solution demonstrates upwards of 30% of all claim line items denials can be avoided. The platform provides immediate guidance for online correction prior to submission. Our edit engines comb through each claim assessing for Payer-specific edits, SNIP edits, Coding & Billing edits and Compliance edits, streamlining the process into a single, simple workflow, reducing time to complete and improving accuracy. 
 

By taking a proactive approach to denial management, healthcare providers can improve their revenue cycle management, reduce costs, and improve patient satisfaction. Get in touch to learn more about Exela’s denials management solution.  

A healthcare provider’s first priority is patient care, but there are also many business aspects that need to be considered, from remaining competitive, to profit, to expansion. It's no wonder that the healthcare industry lags behind other market sectors in implementing automation given the complexity of the business itself. However, with the healthcare industry facing staffing shortages and given the gains to be made through automation, healthcare providers need to step up their digital transformation efforts. 

According to recent research, robotic process automation in the healthcare market is expected to hit around $6.2 billion by 2030, compared to $2.9 billion in 2022, with a compound annual growth rate of 26.01% from 2022 to 2030. With digital solutions rapidly increasing in healthcare, providers that fall behind in digital transformation will also fall behind their competitors. 

What Does Automation in Healthcare Look Like 

Many healthcare providers rely on outdated systems that require tedious manual tasks which take up a significant amount of employees' time and often result in errors. This is where healthcare automation can make a big difference. From submitting claims, to denials management, to revenue integrity, healthcare automation can reduce the amount of time that employees spend on these manual tasks by hundreds of hours.

Healthcare technology not only benefits providers, but patients as well. We've already seen the benefits of improved convenience associated with telehealth services or self-service options for patients who set up their own appointments in a system rather than waiting on hold for a customer service representative. It's time for healthcare organizations to start relying more on technology to improve all stakeholders’ experiences.

With any type of automation, leaders need to be very cognizant of how their employees will accept it. One way to help streamline this process is to make sure that all employees feel comfortable with the technology in place through multiple training environments and communications channels to discuss the functionality.  Allowing healthcare professionals to focus on their core competencies, while the healthcare industry advances, is key to success.

One area where healthcare automation makes a significant impact is in the denials management process.

Automating Denials Management

Traditional approaches to denials management include the use of multiple systems and even manual processing, creating an inefficient system prone to errors. This results in wasted time and resources, creates confusion and extra work, and contributes to revenue leakage. With an average of 6 - 13% of claims denied, denials management is essential to avoiding revenue leakage. If a hospital averages 1 million claims submitted annually, with a denial rate of 6 - 13% and a rework rate of $25 - 118, providers could be losing anywhere from $1.5 - 15.3 million a year. If they chose not to rework the claims, they could be losing even more. This inefficient legacy process is a prime example of where automation can make a significant difference.

Exela’s automated denials management solution has a record of identifying upwards of 30% of claim line items denied that could have been avoided. Exela takes a “denials avoidance” approach to the claim submission process, working to prevent denials before they happen. On top of that, Exela’s system is streamlined, providing convenience and efficiency. With over 35 years of experience, Exela supplies providers with simplicity, standardization, and consistency through a single system. So, say “goodbye” to multiple systems and say “hello” to optimization. 

Submitting Clean Claims Up Front

Exela’s PCH Global platform combs through claims and flags any certain-to-deny items, preventing denials before the claim is even submitted. The platform’s edit engines assess each claim for Payer-specific edits, SNIP edits, Billing & Coding edits and Compliance edits. Where once this assessment required multiple systems, PCH Global streamlines it into one user-friendly platform. 

The PCH Global platform also provides guidance for online correction so users can quickly act prior to submission. This creates a single, simple workflow that reduces time spent on denials management while improving accuracy.  

Addressing Recurring Issues in Denials Management

When claims are suspended or denied, Exela’s denials management solution provides root cause analysis (RCA) to spot trends, thus preventing the same issues from reoccurring. By continually assessing claims submissions and analyzing aspects of the denied claims, Exela’s solution identifies the root cause to reduce the number of denials. 

Exela’s denials management solution also provides dashboard reports to bring more visibility into the process and further improve accuracy. Using analytics tools, users can not only identify existing areas of revenue leakage, but also discover new ways to increase savings. As the denials management system continues to collect data over time, it will provide insights into key trends while tracking the root causes of common errors in real-time. By enhancing visibility into the denials management process, providers can make more informed decisions about their claims processing operations moving forward.

Simplifying the Process

Denials management is a great process to automate due to its capability to prevent revenue leakage, streamline processes, and improve accuracy. While many providers already have systems in place for denials management, it’s time to take a hard look and determine if the systems are really delivering the highest levels of optimization and accuracy for your organization.  Consider if your systems are using the latest technology, minimizing the amount of labor hours required, and providing the results that are needed to address and prevent denials. If not, it might be time for a change. 

Our denials management solution provides a single platform that addresses the entire claims editing and submission process. With Exela’s solution, you’ll be taking a denials avoidance approach, working to correct claims before they’re submitted. Exela’s solution minimizes manual, error-prone processes to streamline operations, reduces denial rates, and ultimately, improves your organization’s cash flow. 

Named a Leader in Everest Group’s Intelligent Automation in Healthcare – Solutions PEAK Matrix® Assessment in 2022, Exela’s healthcare automation tools drive positive outcomes and exceed expectations. Learn more about Exela’s denials management solution today.

Medical records management has evolved over the years as more healthcare organizations became interconnected and regulations changed, adding layers of complexity to the process. However, the importance of medical records management has remained constant, given that these records contain patients’ medical histories. With that being the case, proper records management is imperative to confirm that providers are giving the best care possible for their patients.

The Center for Medicaid and Medicare Services (CMS) recommends, and in some cases mandates, that medical records are maintained within an electronic system. Many providers are experiencing a shift to storing medical records as digital assets. Where once providers may have owned numerous file cabinets filled with documents on each patient they saw, now they have the option of digitizing all these assets for a smoother records management workflow. 

Defining Medical Record Terms 

Medical records refer to documents that detail a patient's medical history, which includes any symptoms they experienced, clinical findings, physician notes, diagnostic test results, progress, various treatments, operations, medication, and the like. 

Due to the number of patients many providers see and the amount of time needed to retain medical records as per federal and state regulations, physical paper takes up a lot of space and it makes sense to digitize these assets. Thus, many providers are implementing electronic medical records (EMRs) and electronic health records (EHRs). An EMR is a digital representation of the medical record maintained by a single provider whereas an EHR focuses on the complete health and broader view of the patient and can include information from multiple providers. 

According to the CDC, 89.9% of office-based physicians use an EMR or EHR system. By using an EHR system, healthcare providers experienced many benefits including improved workflows, easy access to documents, and more space that was previously used for with physical documents. 

Even with these benefits, providers still encountered challenges with EMR and EHR systems and this is where medical records management comes into the mix. Not only are medical records needed for patients, they may be needed for any malpractice lawsuits, medical billing audits, compliance issues, and licensing board complaints. Because of this, there's substantial pressure on hospitals and other healthcare organizations to improve, streamline, and create a satisfactory system for the management of their medical records.

The Importance of Medical Records Management 

Medical records management encompasses the entire life cycle of the record from the creation to the digitization to the disposal. What's more, it requires procedures and protocols to affirm the security of the record. 

A medical records management system streamlines management processes making it easy for providers to digitize, maintain, and search for health records. It can also make it easier to transfer information between offices and share between patients and physicians who need to access this information in a timely manner.

When medical records are mismanaged, it puts the patients and organization at risk. Some issues with mismanagement of medical records include:

• Lacking easy access to patient records, requiring time for physicians and staff to find and obtain records. 
• Lack of organization can not only be detrimental to a patient's health, it may also slow down processes and increase spend due to the resources required to locate documents.
• Without a standardized system in place, employees may create a non-standardized system that could cause issues in the long run. This can result in wasted resources, unnecessary spending, and expose the organization to compliance issues.  

Best Practices for Medical Records Management 

Medical records management is an imperative aspect of the healthcare administration process to ensure that physicians and staff are delivering the best possible patient care they can. To help providers better manage their medical records, there are several best practices to follow: 

Create a Standardized Procedure for Records Management

The first step is to define and notate policies and procedures for employees to follow when it comes to managing records and maintaining security. According to the Health Insurance Portability and Accountability Act (HIPAA), healthcare organizations need to have written security policies and procedures along with "written records of required actions, activities, or assessments." Given that retaining medical records is an important part of patient security, organizations need to create clear guidelines for managing records.

Utilize Healthcare Automation Tools

Due to federal laws, state laws, and compliance mandates, there is little room for human error when it comes to medical records management. Unfortunately, humans make mistakes. Automation, on the other hand, is much more accurate and by automating tasks, organizations can improve accuracy and consistency while freeing up resources to work on less repetitive and time-consuming tasks.

Enhance and Standardize Employee Training

Healthcare records are accessed by various employees in the organization so it's critical for all staff to understand the proper way to manage records. Providing detailed guidelines as mentioned before is part of this, but another important part is ensuring that all employees are trained in managing records properly. Writing guidelines and hoping that employees know where to find them and follow them isn’t enough. Employees need to be trained in these standardized procedures to ensure compliance. 

Audit Medical Processes

To confirm that your organization is up to date on all compliance standards, it needs to perform audits. This can prevent costly fines or investigations. If there is a reported violation by an organization, it can trigger a HIPAA audit where investigators will need to comb through all policies, procedures, and processes to ensure that everything is in compliance with HIPAA regulations.

Looking into Medical Records Management Solutions 

Medical records management may seem like a cumbersome process, but the good news is that our solutions help providers make managing records easier. Exela’s Medical Records Management solution aggregates and transforms physical and digital documents into searchable digital assets. This provides an efficient path to downstream processing including coding, auditing, and accelerated reimbursement decisioning. 

Given the likelihood of regulations changing, Exela’s Medical Records Management solution remains flexible and ready to adapt to any new requirements and customer needs. Speaking of flexibility, this solution can operate onsite, offsite, or as a combination hybrid, giving more control to the organizations. It also has the capability of integrating with major EMR and EHR systems that providers may already have in place.

Exela’s Medical Records Management service offers a cloud-based document management system that allows organizations to maintain medical records and documentation in a single, user-friendly, HIPAA-compliant solution. With its enhanced search functionality, it provides a highly efficient process for auditing medical records and offers multiple search options. With the web portal, organizations have full visibility into the management process. 

Conclusion 

Healthcare digital transformation solutions like Exela’s Medical Records Management show organizations just how powerful automation and digitization can be. Given the importance of medical records management, providers need to do all they can to ensure that their compliance guidelines are in place, their records are secure, and their processes are streamlined. By using automation, healthcare providers improve workflows, enhance security, and rid themselves of the burden of tedious and inefficient manual tasks. 

One of the top challenges facing the healthcare industry and the revenue cycle is the medical billing system. The medical billing system encounters many obstacles due to the changes that occurred (and continue to occur) during the COVID-19 pandemic as well as the complexity of the billing system itself. Along with increasing regulations and standards, healthcare providers need to find ways to streamline the billing system. Because the billing system is repetitive in nature, it makes the perfect process to implement digital transformation. 

Business automation in the medical billing system increases efficiency, speeds up payment posting, and improves the revenue cycle. The medical billing system is often the first element to be automated in the revenue cycle, usually because providers may be using an outdated billing system or notice higher claims denials. Employing automation in the billing system helps providers to enhance the process, avoid surprise bills, and focus more on patient care while reducing spending.

Complex Processing of the Billing System 

Rather than being handled by a single department, the medical billing process requires input from multiple departments including the billing department, administrative department, and clinicians. With so many seemingly unlinked departments working together, there's bound to be room for error, slow processes, and inefficiencies.

Also, healthcare providers don't typically receive payment upfront. They first work with payers for reimbursement before deciding if they need to bill a patient and, if so, for how much. Healthcare providers need to consider a patient's copay, medical coverage, and insurance eligibility. At the same time, providers need to confirm that claims are accurate with the proper medical codes to avoid denied claims. 

Business Process Automation Improves the Revenue Cycle

When it comes to enhancing the revenue cycle, the medical billing system needs to be taken into consideration and healthcare providers need to consider how business process automation fits into their overall digital transformation and revenue goals. According to a 2021 CAQH report, transitioning to fully electronic transactions could save the healthcare industry 48% of annual spending.  There are various customizable digital solutions that healthcare providers can rely on to make repetitive tasks more efficient, free up resources, and ultimately, reduce spending. 

Fewer Denied Claims

Currently, healthcare providers report that claim denial rates are between 6% and 13%. A denied claim is lost revenue and many claims are denied due to minor errors. With business automation such as Exela’s Lockbox, healthcare providers would see fewer denied claims.

Exela’s Lockbox improves the first pass rate of claim submissions by identifying and flagging medical coding and billing errors before the claim is submitted. By increasing the number of clean claims submitted, healthcare providers receive reimbursement more quickly.

Along the same line, once a claim is denied, it requires the provider to decide if the denial needs to be appealed, the claim needs to be adjusted, or the patient needs to be billed. Business automation solutions such as Exela’s Lockbox increases the recovery rate on denied claims thanks to a tool that presents the original claim along with all the related information in a single view. This makes it easier for the billing department to decide the next steps to recoup the payment.

Mitigate Human Error

As long as there are manual processes in place, claims will always be prone to human error. With claims being denied based on the smallest inaccuracy, healthcare providers can easily lose revenue due to human error. Automation ensures accuracy, removing another obstacle toward streamlining the revenue cycle.

Digital Document Management

Paper systems are inefficient, tedious, and risk documents being lost. Healthcare providers are choosing to transition to digital documents and digital archives to store all pertinent data and information. Exela’s Lockbox converts paper EOBs into EDI 835 remittance files while also providing full support for paper and electronic payments.

Providers can also access information such as EOBs and other data through Lockbox’s secure web portal. With a simple search, a provider can find exactly what they're looking for rather than manually sifting through paper files.

Increase Speed of Payment Posting 

Due to the different departments being involved in the medical billing system along with any outdated system that's currently in use, the path toward payment is going to be inefficient and significantly slower. By using automation tools, healthcare providers reduce the time it takes for payments to post, giving them faster access to deposited funds.

Let Business Automation Improve the Revenue Cycle

While the medical billing system is a great place to start for digital transformation in healthcare, healthcare providers can find a myriad of business automation processes that can enhance their revenue cycle, and encourage them to save money while increasing patient care.

There's no one-size-fits-all when it comes to a solution, which is why healthcare providers should determine what needs to be prioritized in their own organization. Whether healthcare providers start automating the medical billing system or automate a different facet of a healthcare process, it's high time that the industry embraces digital transformation.

While still in the midst of a pandemic, the healthcare industry is settling into a “new normal.” The pandemic has not only shined a light on existing issues within the healthcare industry but created new challenges as well. Healthcare organizations are struggling to decide what to prioritize between these new and existing issues while staying on top of the ever-changing pandemic situation and its effects on the healthcare industry.

Now more than ever, leaders in the healthcare industry need to stay ahead of upcoming challenges and prepare for how to improve healthcare processes for this year. Below is a brief breakdown of five challenges facing the healthcare industry that should be considered a priority for 2022.

Integration of Virtual and In-Person Appointments

Throughout these last two years, telehealth appointments became ubiquitous to keep everyone safe. While the pandemic waxed and waned, the desire from the public to continue virtual appointments remained steady with 88% of Americans preferring virtual appointments. Healthcare organizations scrambled to effectively incorporate virtual appointments and many still scramble to this day.

Now that most healthcare organizations implemented virtual appointments and continue to use them, it's time to look into more effectively integrating virtual and in-person appointments. One major challenge facing healthcare leaders in 2022 is deciding which appointments can be virtual and which appointments should remain in-person. This may depend on the type of appointment, the healthcare practitioner, or health care protocols.

At the same time, healthcare industry leaders need to balance revenue integrity while delivering the best patient care in both virtual and in-person settings. This includes finding the right platforms and business automation tools to help healthcare practitioners and patients alike.  

Cyber Security

With the challenge of integrating virtual and in-person appointments comes the threat of cyber security. While many healthcare organizations put safeguards into place as virtual appointments became the norm, cybersecurity requires constant vigilance and quick responses.

If a breach occurs, private patient information could be leaked, which could lead to a healthcare organization facing penalties, particularly if they violated the industry’s compliance standards. Knowing what's at stake, healthcare leaders need to ensure a team is prepared to handle any cyber security breaches while implementing the proper safeguards to ensure client confidentiality.

As healthcare organizations continue to integrate technology and business automation, it's also imperative to ensure that any third-party vendor an organization partners with is compliant with HIPPA. Third-party vendors such as Exela Technologies offer products that are compliant with the healthcare industry standards.

Increasing & Adapting to Automation

The healthcare industry has been slow to adopt automation processes. While organizations focused on technology that advanced the consumer experience, healthcare automation to help clinicians and workers fell behind.

This leads to a huge loss in the healthcare industry as automation frees up time for healthcare practitioners to focus on patient care while reducing errors in processing. An example of this is the payment processing systems that many healthcare organizations utilize. 

Many organizations developed in-house solutions to manage their payment processing. However, these solutions often demand more resources and tend to be slower than purpose-built solutions from third-party specialists. Solutions like Exela’s Medical Lockbox alleviates these issues, simplifying the payment process while freeing up time for healthcare workers to focus on their core competencies. Consolidating all incoming receivables, Medical Lockbox speeds up the payment process ensuring healthcare providers receive accurate payments. 

Mental Health of Healthcare Practitioners

Practitioner burnout has been a concern in the industry for years and, given the effects of COVID, should be at the forefront of the healthcare industry for 2022. According to a 2020 survey, 49% of nearly 21,000 physicians and other healthcare workers reported experiencing burnout. Burnout not only affects the mental well-being of the healthcare worker but also their ability to deliver quality patient care and quality work.

Due to healthcare worker burnout, organizations experience reduced employee hours, physician turnover, and the time and expense of hiring replacement healthcare workers. It is estimated that the healthcare industry loses 4.6 billion a year due to physician burnout. With the increasing percentage of healthcare workers experiencing burnout, it’s more important than ever that healthcare organizations find ways to help support the mental health of their workers.

Claims Processing

A known cause of revenue leakage is the tedious, costly, and cumbersome task of claims processing. With many claims being denied due to minor errors and the cost of manual processing, it’s time healthcare organizations look into ways to automate their claims processing operation. On top of that, insurance companies have shown a 77% payment accuracy rate, requiring healthcare organizations to look into and recoup any lost income.

Solutions like Exela’s PCH Global aid healthcare organizations in automating claims processing, decreasing first-time claim denials, and identifying inaccurate payments. Exela’s edit engines contain more than 119 million recommendations based on general care guidelines for commercial Medicare and Medicaid processing. With these engines, PCH Global corrects any errors in the claim, thus submitting clean claims that are more likely to be accepted within the first submission.

With PCH global, Healthcare organizations can automate and streamline their claims processing, which leads to better revenue integrity and allows healthcare workers to focus on their core competencies.

For more information on claims processing and preventing revenue leakage, take a look at Exela’s PluggedIn newsletter on Revenue Integrity.