From verifying your patients’ eligibility to processing the claim and payer payment, the claim management lifecycle is extensive and complex. With the constant change of the reimbursement landscape, your biller needs to investigate a claim management solution that pivots in step as insurance requirements change.
As your billing manager looks to blend their knowledge of the reimbursement process with a robust claims management solution, there are a few things they should assess from potential claims management vendors.
Our friends at ZirMed have offered their insight into the investments that your claims management vendor should be making to ensure you’re fully reimbursed for the care you provide—as quickly and efficiently as possible.
3 Investments Your Claim Management Software Vendor Should Make
Automated Claim Monitoring
When your optometric billing manager submits claims to the payer, it’s difficult to track what’s happening and where the individual claims are in the lifecycle. Trying to monitor thousands of individual claims manually is tedious, time-consuming, and can lead to revenue being delayed or even falling through the cracks. And, following up with payers takes more time away from filing new claims—meaning new revenue is delayed too.
Your claims management solution should invest in features that automate and monitor your claims to give you insight into how the payers are progressing the claims. The automation and monitoring will free up your biller’s time to focus on following up only when it’s needed.
Adapting to Industry Changes
With value-based performance programs such as MACRA and MIPS taking root in the healthcare industry, your claims management solution should also be able to deliver value-based program reporting—so you can more easily achieve optimal value-based program performance.
Eliminate Lost Remits and Reconciliation Pains
Due to the tremendous shift in how reimbursements are being calculated—moving from fee-for-service to fee-for-value—there will be a lot of challenges in transitioning to the new payment criteria. This could create more bottlenecks in your claims management process and lead to lost remits and reconciliation errors. To ease the pains and prevent disruption, your claims management vendor needs to invest in the technology that will help your biller adapt to the new requirements more quickly while simultaneously reducing lost remits.