With all of the pressure surrounding hospitals and unintended consequences of the latest vaccine recommendations, it’s not surprising that hospitals are struggling with staffing shortages. More than 17 million healthcare workers across the nation are affected, including hospital billing departments as systems implement their policies company-wide.
With mounting heat to do more with less, hospital leaders are doing everything they can to maximize profitability and streamline claims processing efficiencies. Even with these efforts, it’s no secret that complex claims present extra layers of challenges for a hospital’s billing staff that are not typically dedicated, well-versed or have the necessary experience to deal with non-traditional payers (unless you found that unicorn!).
According to a recent study in RevCycle Intelligence, approximately 77% of administrators believe outsourcing complex claims improves productivity of in-house staff and frees up their time to focus entirely on optimizing traditional claims. With a specialized complex claims partner, providers reduce the headache associated with working the 7-10% of complex claims such as Veterans Administration, Workers’ Compensation, Motor Vehicle Accident/Third-Party Liability, and general Denials Management; while gleaning a net positive alternative! (i.e. Headache: Gone & Revenue: UP). Embracing the 80/20 rule, the decision to seek a complex claims partner becomes advantageous on many fronts.
Trust and full transparency are important attributes in a successful partnership to supplement RCM efforts. The small classes are small, but still important and need to be managed. Having a partner to handle the higher CTC classes allows the RCM team to focus on larger payer classes and drive the 80% that really moves the needle!
A popular mantra holds true in RCM: Divide & Conquer! Considering 80%+ of provider revenues come from traditional (commercial/group health/government) payers, it makes perfect sense why 100% of RCM attention is focused in that area.
In addition, there is an unspoken truth that payers are betting on the provider’s revenue cycle not having the ability and resources to focus on the non-traditional claims. This ultimately, results in uncontested short pays, unnoticed silent PPO discounts applied, uncontested zero-pays, and/or claims worked by those not skilled enough to successfully create a positive outcome.
Therefore, the time is NOW! It’s time for providers take a stand and buck the unspoken truth that the payers have come to expect. With hospital margins continuing to be squeezed and reimbursements declining, providers can take charge: analyze where focus is spent and weigh the facts on getting better results with higher yields by actually spending less. An opportunity exists to increase cash recoveries by shifting “headache” claims to an external partner and refocusing staff to the higher ROI claims like commercial, simply by rethinking the approach.
That’s where we come in.
Our Partners have seen the progressively positive outcomes and have been able to truly turbocharge their performance to the tune of seven additional figures on average. By focusing on the core traditional business and trusting us to deal with the 7-10% associated with complex claims, we enable providers to focus, embrace their staffs’ payer skillsets, and see their RCM teams SHINE!
After all, results speak for themselves. Over 800+ healthcare organizations have entrusted EnableComp to be their trusted partner. We improve complex claims yield performance and positively supplement a myriad of attributes:
- Improve staff productivity by processing 400%+ claims per day per FTE
- Add team members to improve commercial claims
- Recover significantly more VA/Military Payer cash quicker, receiving payments up to 70 days faster
- Improve Workers’ Compensation cash yield, both in and out of state, performing at the highest level of the state fee schedules
- Clean-claim rate improvements and providing dedicated analytics supporting HIM, Coding, Audit, and more
- ELIMINATING COMPLEX CLAIM DENIALS!
With EnableComp’s subject matter expert team, payer relationships, and specialized technologies to handle complex claims, healthcare RCM leaders can remove the stress from staff caused by non-traditional claims and empower them to focus on what really counts. When you’re ready, so are we.