Why Claims Management Is So Hard and What You Can Do About It

Posted by Jeff Rezabek on Tue, May 08, 2018 @ 15:05 PM

If you think staying on top of your claims management is difficult, then you’re not alone. Effectively managing insurance claims and maximizing your reimbursements is difficult. Unfortunately, with the pressures of online retailers cutting into your frame profits, increasing your reimbursement revenue is becoming more important.

This post highlights some common claim management challenges and provides two options for resolving the obstacles.

4 Reasons Claims Management Is DifficultDiscover the common challenges with claims management and learn how you can overcome the challenges.

Complex Rejection Management

Promptly responding to rejections can be the difference between a denied claim and added reimbursement revenue. However, most rejected claims go unresolved because the billing manager is swamped trying to keep up with the new claims to submit to payers.

Lack of Visibility

Not having visibility into your claim performance keeps you from making informed decisions that help your practice succeed in collecting reimbursements. To manage your claims effectively, you need to have insights into your claim performance to understand your monthly denial rate and the time it takes a payer to accept a claim. Unfortunately, the demands of an optometric billing manager make it difficult to compile and analyze the data without falling behind.

Lack of Resources

Not having the right people or tools in your practice to manage your claims will only complicate an already complex task. To manage claims effectively, you need to have a billing manager that knows your practice and the payer guidelines. But, the billing manager also needs to have the right software to help them submit and track claims across the claim lifecycle.

Lack of Claim Knowledge

High turnover rates lead to practices pushing staff members into the billing role while they try to hire a new billing manager. Unfortunately, the learning curve for a billing manager is steep because of all of the intricacies between payers. When you throw a staff member into managing claims, they often don’t know the claims management lifecycle or how to handle rejections. This added stress can lead to staff burnout and denied claims.

Resolving Claims Management Challenges

Use A Clearinghouse Solution

If you want to keep your billing in-house, then you need to use an advanced clearinghouse solution that will enable you to access thousands of payers to submit and track claims from a single dashboard. With an advanced clearinghouse solution, you can reduce your chances of a claim denial with the help of built-in claim scrubbing features and workgroups.

Hire A Revenue Cycle Management Service

Some practices may still struggle to capitalize on their claim reimbursements, even with an advanced clearinghouse solution. Challenges with understanding the claim lifecycle and managing a large number of claims and rejections cause optometric practices to miss out on money they earned. Leveraging the help of a Revenue Cycle Management Service will provide practices with a team of optometry billing experts that they can use to:

  • File claims quickly
  • Resolve rejections
  • Track claim performance

Want more tips on how to maximize your claim reimbursements? Download "The Definitive Guide to Making More Money on Claim Reimbursements."

Download Your Guide

 

Tags: Tips & Tools, Electronic Claim Filing, Revenue Cycle Management

Looking for tips to grow your eyecare practice business? Read on!