Claims denials present a significant challenge in healthcare revenue cycle management. Stemming from various factors, from simple administrative errors to complex issues such as coverage disputes, these denials can affect an organization's financial health. The American Medical Association (AMA) estimates that approximately 9% of hospital claims are denied on the first submission, indicating the magnitude of the problem.

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The Role of a Revenue Cycle Management Partner

A tech-enabled Revenue Cycle Management (RCM) partner is an asset. Not only can they work on resolving denials, but they also bring significant value to healthcare claims processing by relying on technology to automate workflows and reduce the errors that lead to denials. For instance, they can pre-validate insurance information, cross-check for coding accuracy, and even flag potential issues before claim submission.

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The Power of Technology in Claims Processing

How important is technology in claims management and processing? A 2020 research paper showed how an RCM company using advanced machine learning algorithms could predict claim denials with 95% accuracy. This helped healthcare providers take proactive measures to reduce denials, boosting revenues. Similarly, a case study by Accenture highlighted how automating claims processing workflows can lower claims handling times up to 20% and cut claim recovery times up to 30%, leading to improved revenue flow.

An RCM partner using advanced technology can also dissect denial patterns, identify underlying causes, and formulate strategies to reduce future denials. This goes a long way in managing denials and preventing them. With fewer denials and more efficient claims processing, healthcare providers can focus more on their primary task—patient care, while their RCM partner handles the financial side. By tackling the complexities of claims denial, these partners help healthcare providers navigate the maze with confidence, optimizing their financial health.

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How pMD^® Can Help

Here at pMD^®, our mission is to streamline and optimize the patient care episode and the revenue cycle. Through our advanced, end-to-end practice management and revenue cycle solutions, we can help practices consolidate vendors, reduce costs, streamline workflows, improve patient care and satisfaction, and collect their maximum reimbursement more quickly.

Not sure what a vendor could do to improve your behavioral health billing? Contact pMD^® for a no-commitment financial impact analysis by our team of healthcare RCM experts free of charge!

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