A Medical Coding Company Can Help Providers Prevent Fraudulent Error(s)

The financial health of a practice relies heavily on accurate medical coding. Selecting the wrong code is not only much more likely to result in a claim denial but it can lead to the wrong treatment being given, as well as illegal consequences. This usually happens in three ways: the facility ends up choosing a code for a milder treatment than what is really needed (undercoding), chooses a code for a more expensive treatment (upcoding) or reports separate procedures that can usually be combined, therefore falsely increasing reimbursement (unbundling).

In some cases, upcoding is accidental. A coder may misread clinical documentation or misunderstand a diagnosis due to lack of physician documentation and may inadvertently choose the code for a more expensive treatment. However, some practices have exhibited intentional upcoding and unbundling.

Both intentional and non-intentional upcoding can have damaging effects on providers. To prevent this, providers looking to ensure they have accurate medical coding and true reimbursements should partner with an experienced medical coding company. ECLAT Health Solutions can guarantee a 95% coding accuracy or greater to ensure our clients prevent these inaccuracies. Below, we’ll cover the various consequences providers can avoid by choosing to work with our medical coding experts:


Potential Increased Financial Burden on Provider

When upcoding or unbundling is successful, of course, the facility enjoys falsely-acquired, increased revenue. However, the financial consequences of when this fraud is detected far outweigh the benefits. If the incorrect code is discovered by the insurance provider during claims processing, this will result in a claims denial, which can carry a hefty price tag.

This is nothing compared to the cost of being reported and found guilty of healthcare fraud. Last year, Carolinas Healthcare faced a $6.5 million fine for upcoding lab test results. They received $80 more per urine test they conducted than they should have, resulting in false revenue. This revenue did not surpass, however, the huge fine they ended up paying.

Providers should not take this financial burden lightly. Choosing coding specialists like ECLAT Health Solutions is the best way to ensure all codes are chosen accurately and the provider steers clear of fines.


Potential Increased Bills for Patients

Upcoding and unbundling is bound to result in a higher cost for a patient. There has been a large increase in financial responsibility falling to the patient in recent years, and upcoding and unbundling can only contribute to this. If a patient’s insurance does not fully cover the more expensive treatment reported with the coding, they will need to pay more out of pocket. This can in turn affect their decision to remain loyal to a provider or seek elsewhere for less expensive treatment, which ultimately affects revenue.


Coding Audits & Investigations

Providers who draw attention with their upcoding are likely susceptible to coding audits or criminal investigations. Because upcoding and similar fraud like unbundling costs the healthcare industry billions of dollars annually, the penalties for these offenses are severe. Not only does upcoding cost facilities a lot of money, as in the case of Carolinas Healthcare, but can damage their reputation and credibility with patients, insurance providers, and other practices alike. Even if a provider is not found guilty of upcoding, investigations send a negative impression to the public.

HHS has begun cracking down on healthcare fraud and developed a proactive approach to fraud protection that hopes to detect more fraud issues. Part of these measures include using predictive analytics to prevent false medical bills. It has become increasingly crucial that providers take every possible measure to prevent upcoding, whether intentional or unintentional. There are serious legal implications and consequences of fraud and abuse. Learn more about these implications here.


Choose ECLAT, Your Trusted Medical Coding Company

Trusting a medical coding company to handle your daily coding is the best way to ensure accurate codes and no upcoding. ECLAT Health Solutions not only helps providers increase their coding accuracy but identify potential inefficient practices or other areas of concern to prevent accidental, or intentional, upcoding. It is everyone’s responsibility to report accurate information based on patient documentation, reflecting the severity of our patients and the costs associated. We work closely as an extension of our clients to help them become proactive in their coding practices and earn a true ROI.


Benefits of Offshore Medical Coding for Your Domestic Staff

More and more healthcare providers are utilizing offshore medical coding and are enjoying a variety of benefits. One of the biggest appeals of offshore medical coding for many providers is the bottom line – hiring overseas coders is more cost-effective than searching for employees at home. This is a huge asset for providers, but it certainly is not the only one. Financial incentives aside, outsourced medical coding also has several benefits for a facility’s domestic staff. Below, we explore some of the ways that offshore coding can benefit your domestic employees.


Freedom to Focus on the Administrative Side

Outsourcing your medical coding practices leaves your domestic employees with more time and resources that they can put toward bolstering and reworking other areas of your facility that need help, such as your administrative tasks. Refining the administrative side can help improve your facility’s billing and collections practices, patient experience, and claims submissions process, all of which will help increase efficiency and foster a healthier revenue cycle. Any staff who may have been doubling as coders or assisting with coding processes will now be free to focus on their main roles and responsibilities.


No Need to Re-Train Domestic Employees

Healthcare providers that feel their domestic employees’ lack of training has affected their efficiency or revenue may dread the effort, money, and resources that they will need to put into retraining them. Offshore coders are joining the workforce with the same qualifications, skills, and training as new coders in the United States at a reduced cost, making them capable of providing accurate medical coding and maintaining security. When providers look overseas for their coding solutions, they eliminate the need to spend valuable funds on training programs for their domestic staff. Offshore coders will need to receive some training to become familiarized with your facility’s best practices and procedures, but this is minimal and spares your facility the cost of a complete training overhaul that your domestic employees may need. No re-training for domestic employees also saves them time and stress, and allows them to focus on other, more important tasks and processes.


Fewer Errors and Less Stress

Using skilled offshore coders for your medical coding needs can help drastically reduce medical coding errors. In some facilities—often small or understaffed ones—busy staff may be prone to making coding errors, especially if these domestic staff are new to the workforce or have been struggling with the switch to ICD-10. Highly trained outsourced coders will likely make fewer errors, which means the rest of your staff will not need to scramble to fix mistakes such as claims denials. Often, the stress involved with fixing errors can actually lead to more mistakes being made, which compromises the health of your revenue cycle.

To earn the benefits of offshore medical coding, both for your finances and your staff, partner with an expert international medical coding company!


Offshore Medical Coding – The ECLAT Difference

ECLAT Health Solution’s team of outsourced medical coding experts are highly trained in ICD-10 coding procedures and are trained to maintain HIPAA and HITECH compliance. Not only is our coding secure and accurate, but our 3-Tiered Quality Assurance Process ensures we deliver superior work every step of the way. During this process, we closely analyze and review any cases that our coding team have questions on and prevent or fix errors. We go above and beyond to help your practice enjoy a healthy revenue cycle and increased revenue with our 24-hour turnaround and holiday and weekend coverage at no additional cost.

Contact ECLAT today to learn more about our offshore medical coding services.

Why HIPAA & HITECH Compliance Is Increasingly Crucial in Today’s World

Healthcare fraud and security breaches have been making headlines recently. It seems that almost everywhere we turn, we hear about a new threat to banking or health information security. After the Equifax breach compromised 143 million Americans’ credit and financial information earlier this year, individuals and organizations are shifting their best practices and regulations to prevent this from happening again.

In the healthcare sector, protecting patients’ personal and financial information should always be the highest priority of any healthcare provider, insurance agency, or healthcare support companies. With the number of these breaches steadily increasing, it has become even more necessary to closely follow HIPAA guidelines and prevent security risks at your facility.


Why Compliance Matters

Regulations and security measures change as new threats arise and as legislation is proposed or adjusted. Healthcare providers must make sure they always maintain compliance, even as these regulations constantly change and evolve. The procedures, practices, and policies enforced by HIPAA and HITECH ensure that confidential patient information and records stays secure, whether stored on paper or online.

HIPAA compliance was not common when the act was first introduced, as many organizations, especially small businesses, found it difficult to maintain compliance. The improvement of technology and the increase of security breaches has made compliance much more widespread, however. In fact, non-compliance is now incredibly detrimental to healthcare and healthcare support providers.

Organizations and facilities who do not comply with these regulations not only face increased risk of a security breach but can also be hit with hefty fines or even jail time for violators. Some of these fines may reach up to $1.5 million per violation per calendar year. In addition, any healthcare provider or organization that does not practice compliance will have a hard time earning and keeping patients or customers.


How ECLAT Maintains HIPAA & HITECH Compliance to Protect Sensitive Information

ECLAT Health Solutions, offering offshore medical coding and medical billing services to hospitals, ambulatory surgery centers, Independent Practice Associations, physician offices, and more, proudly complies with all HIPAA and HITECH regulations. To ensure we are always protecting our clients’ sensitive personal and financial information, we take a variety of measures:

  • Hold bi-annual meetings in which we review our privacy and security standards with all employees
  • Use firewalls, encryption, and restricted Internet access on all of our computers
  • Prohibit patient information from being removed from our offices
  • Disabled all external drives on our computers
  • Monitor and guard our coding facilities 24/7

We always exercise these practices among many others to ensure all of our clients’ confidential information remains secure in our facilities. In addition, we are also SOC 2 Type 2 compliant and have earned ISO Certification. To receive SOC 2 Type 2 certification, an organization have accurate and compliant policies and procedures in place that protect all sensitive information. ISO certification verifies that an organization meets all the necessary requirements for security and quality assurance.

As an organization, we strive to uphold our accreditations and adapt to the changing healthcare security landscape. ECLAT’s medical coding services are always secure, efficient, and accurate. We work as an extension of each our clients’ organizations, and we treat their security concerns just like our own. This is why we are vigilant regarding compliance with regulatory and best practice standards, keeping our clients’ and their patients’ sensitive information as secure as possible.

Contact us today to learn more about how we maintain the highest security and compliance in our offshore medical coding and billing services!

Highlights and Trends from AHIMA 2017

The feeling of absolute exhilaration was in the air lining up to receive pre-registration packets at the AHIMA 2017 Convention and Exhibit in “the city of angels”, Los Angeles.   For many of us, it had been a year since we had seen colleagues, reconnected with prior co-workers and reunited with friends in the health information profession.  Flipping through the agenda, the hard work of all the sponsors and contributors was evident; this would be a convention to remember!

Pre-conference meetings and events as well as post-conference meetings and events were available.  Saturday and Sunday were packed with the Clinical Coding Meetings.  Truly there was something of interest for everyone.  AHIMA celebrated another year of “go green” with limited printings, replaced with easy to follow download links to access all the conference handouts.

Clinical Coding Meetings

Highlights of the Clinical Coding Meetings include FY 2018 ICD-10 CM and ICD-10 PCS code and guideline modifications as well as inpatient prospective payment system (IPPS) changes that impact coding and documentation were presented by Sue Bowman, MA, RHIA, CCS, FAHIMA and Anita Rapier, RHIT, CCS.  New codes were discussed including the types of acute myocardial infarction and pulmonary hypertension.  Garry L. Huff, MD, CCS, CCDS held a separate session that further defined acute myocardial infarction and the types of myocardial infarctions, acute coronary ischemia and demand ischemia.    Bowman and Rapier continued with clarification regarding the word “with” or “in” to be interpreted to mean, “associated with” or “due to” when it appears in a code title, the Alphabetic Index, or an instructional note in the Tabular List was discussed.  The exception was further clarified to be “unless the documentation clearly states the conditions are unrelated or when another guideline exists that specifically requires a documented linkage between two conditions (e.g., sepsis guideline for “acute organ dysfunction that is not clearly associated with the sepsis”).   Procedure Coding System (PCS) codes were revised and deleted to mostly simplify certain body part values or to correct clinical discrepancies and add new devices.    There were a few DRG shifts that coders need to be familiar with when grouping discharges from October 1, 2017 forward.

Audit was a hot topic during the sessions, highlighting the need for auditing, what and why to audit and what to do with the data being analyzed as a result of an audit.  Frequency and volume of auditing was also discussed.  Data analytics, revenue integrity adventures, coaching the team, goal setting and risks were all included in sessions.  There were physician tracks, HIT, coding and CDI tracks as well as international sessions, population health, workforce development, payment reform and information governance.

AHIMA General Session

General Session was certainly a highlight with Dr. Don Rucker, National Coordinator for Health Information Technology, Barbara Boxer, former U. S. Senator, and Newt Gingrich, Former Speaker of the U. S. House of Representatives.  AHIMA Triumph Awards, AHIMA Grace Award and the Presidential address set the tone for the 2017 Convention themed, Inspire, Innovate, Lead.

Exhibitors were armed with the latest in technology, practice and support.  This was one of the most enjoyable events with demonstrations, prizes and entertainment, not to mention all the wonderful giveaways to assist in recalling the name and number of the vendor when the need arises.  The AHIMA Foundation Silent Auction is always a fun event and this year was no exception.  The paper auction was replaced with an APP that provided on-the-spot notification when your bid was overtaken, allowing an up-bid to take place with the touch of a button.

AHIMA Gala to Remember

Time to dress for the red carpet came on Tuesday evening at the AHIMA Appreciation Celebration:  Lights! Camera! ACTION! Gala.   This was the event of all events as guests were met with a real-life feel of celebrity, cameras flashing upon entering.  Delicious food, drinks, entertainment, picture-taking with Pirates of the Caribbean, Alice-in-Wonderland, Dinosaurs, a candy bar, dancing to a live band and entertainment by the Star Wars Storm Troopers.   A great time was had by all!

Wrapping up the 2017 AHIMA Convention was the inspiring Viola Davis, followed by sessions for Coding, Consumer Engagement, HIM Practice Standards, Hot Topics, Information Governance, Innovation, Privacy and Security, Quality Measures  and Leadership.  On my way back home, I was filled with new ideas and renewed spirit of success.  I’m already planning my trip to Miami, Florida September 22 – 27, 2018 for the AHIMA 90th Convention & Exhibit, “Inspiring Leadership – Influencing Change”.

4 Tips for Reducing Claim Denials

Claim denials are a nuisance for hospitals and other healthcare facilities, and can end up costing millions of dollars in revenue every year. There are, unfortunately, many reasons that a claim may be denied, with anything from a patient simply not having the proper coverage to a coder using the wrong ICD-10 code, and everything in between. Fixing and resubmitting a claim can cost more money and give your staff additional paperwork to work through—in other words, no good comes from a high number of claim denials.

Although it is not likely that you will completely eliminate all claim denials, most claim denials are preventable. It’s crucial that you take the measures you can to reduce claim denials and save valuable revenue. Below are some of our tips for reducing the number of claim denials at your facility.


  1. Improve Employee Training

Undertrained staff can create a myriad of problems for your hospital or facility, and claim denials is one of the most common of these. If your medical coders are not properly trained in ICD-10 procedures or your billing staff continues to make clerical errors, it may be time to take another look at your training procedures. Tweak and refine your process, and retrain current staff if necessary. Make sure your employees are being properly managed, too, with clear policies and best practices in place.


  1. Look for Patterns

Make sure your employees are closely monitoring every step of the claims process, so they can identify any issues that happen over and over again. Investigate why a claim gets denied immediately at the time of denial; it is much more difficult to look back at the claim later and find out what went wrong. When your staff keeps an eye on the claims process and immediately follows up with denied claims to determine the cause, they will be able to spot common patterns and learn how to put an end to them much faster.


  1. Check Patient Coverage Before Treatment

It seems too obvious to say that checking to make sure your patients’ insurance covers the necessary treatment prior to giving this treatment can reduce your facility’s number of claim denials, and yet a whopping number of healthcare providers fail to check patients’ insurance before providing service, or at all! Ensure your administrative employees are checking each new patient’s insurance to find what they are or are not covered for. Routinely doing this will help prevent any surprises after submitting the claim.


  1. Improve Medical Coding Practices

Entering a similar yet incorrect code for a given treatment, or having incomplete documentation that leads to an unspecified code can cause a claim to be denied. Some coders are still catching up to the 2015 transition to ICD-10, and are still making mistakes. Unfortunately, there is no room for mistakes on a claim, and a coding error will most likely lead to the claim getting denied. Your coding processes should be air-tight to ensure your claims will be accepted. An excellent way to improve your medical coding accuracy is to partner with an expert healthcare support provider.


The ECLAT Advantage

ECLAT Health Solutions provides outsourced medical coding services nationwide. We provide 24-hour turnaround and can guarantee a score of 95% or higher coding accuracy, making us the key to helping your facility reduce its claim denials. Our satisfied customers—which include hospitals large and small, physician offices, ambulatory surgery centers, and much more—call our ability to go above-and-beyond with our service The ECLAT Advantage.

Contact us today by filling out this form or calling (703) 665-4499 to learn more about our medical coding services.

Outsourcing Is a Key Method to Reducing Administrative Costs

Your hospital wouldn’t be able to operate without its administrative functions, and your hospital’s expense report will show it. According to the Council for Affordable Quality Healthcare, administrative costs account for a whopping 15 percent of all U.S. annual healthcare expenditures. Such a sizable percentage means the stakes are high for hospitals and other healthcare facilities struggling to maintain a healthy revenue cycle.

Medical billing, medical coding, and claims submissions make up a large portion of your hospital’s administrative functions. Medical coding in particular is the heart of a hospital’s administrative practices. If a code is entered incorrectly, it may cause a claim denial, which will then cost more money to fix. If the claims denial is not fixed and the facility has trouble collecting the necessary payment from the patient, the facility is missing out on key revenue. Additionally, State and Federal guidelines must be obliged seamlessly to avoid any financial penalties and legal repercussions.

Accurate and efficient medical coding is so crucial to healthy revenue cycle management, and yet finding the staff to provide it seems hard to come by lately. The United States has experienced a shortage of trained medical coders in recent years, sending many hospitals and other healthcare facilities scrambling to find employees. A solution, then, is to use outsourced medical coders. Although many hospitals freeze up at the mention of outsourcing, the truth is that using outsourced medical coding staff can save 25% to 30% on administrative costs, something any hospital or healthcare facility could appreciate.

Something that many healthcare facilities don’t consider is that other nations offer a set of highly skilled and qualified medical coders ready to enter the workforce. With this available pool of qualified coders, healthcare providers do not need to spend even more resources, time, and money training domestic, inexperienced staff in ICD-10 code and HIPAA compliance procedures. This rushed training attempt may not quickly produce the highly qualified coders they need, and these ineffectively trained staff members may cost crucial revenue. Some hospitals might try to save money and stretch their current coding employees too thin, which can lead to more errors, which means more claims denials, and ultimately means a loss of revenue.

With an abundance of trained workers, healthcare facilities can meet their demand for skilled workers at a reduced cost, which is an appealing economic business decision for any facility struggling with expenses. Additionally, without having to spend time and resources on in-house medical coders, hospitals and other healthcare facilities can work on improving their patient care services. Focusing on and improving the quality of patient care can also reduce administrative costs and overall bring in more revenue, which means a better bottom line on the next expense and quality report.

Using outsourced medical coders is overall a cost-effective solution for reducing your hospital’s administrative costs. To get the most savings possible, make sure you choose an expert outsourced coding company. ECLAT Health Solutions is a global leader for international medical coding services to healthcare facilities nationwide. Our coding staff are skilled in ICD-10 coding and we can always maintain HIPAA and HITECH compliance to ensure our clients’ security. We work with our clients as an extension of their facility and go the extra mile to help them reach their revenue goals.

Make a change that will reduce your facility’s administrative costs and bring in more revenue. Contact ECLAT to learn more about our offshore medical coding services!

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Why Collaboration Between Coding & Patient Financial Services is Essential for Healthy RCM

There are two key parts to any healthcare facility’s revenue cycle: patient financial services (including enrollment, appointment scheduling, collections, and more) and medical coding. For your employees who work in each department, these two may seem like entirely different worlds sometimes, but communication and collaboration between the two is crucial for effective revenue cycle management. Inaccurate coding can make your hospital lose out on thousands of dollars of revenue each year, so improving the collaboration between patient financial services and coding is the best way to maximize cash flow.

Below, we explain why maintaining a healthy revenue cycle depends on a smooth partnership between patient financial services and medical coding.


RCM begins and ends with Patient Financial Services

The revenue cycle begins and ends with patient financial services, from the moment a patient first picks up the phone to make an appointment all the way through when they’ve made their last payment; therefore, the accuracy of your patient financial services plays a big role in the health of your entire revenue cycle.

A common issue that plagues hospitals and other facilities is a high rate of claims denials, and one reason for so many claims denials is the failure of a facility to properly and accurately check a patient’s insurance eligibility before providing treatment. Medical coders rely on knowing what treatments will be provided in order to transfer these treatments into medical code and submit a claim. A hospital should make sure it properly checks a patient’s eligibility prior to offering treatment to ensure the right information gets to the medical coders.


Where Medical Coding Comes In

Medical coders receive a record of the treatments provided from patient financial services and then must, in compliance with the latest ICD-10 guidelines, accurately use the corresponding code to submit the claim. If your hospital’s medical coding staff makes clerical errors while coding, the claim is likely to be denied. If this claim is not re-submitted, the patient will likely need to pay for the treatment in full. Accurate medical billing relies on accurate medical coding.

Having the most accurate medical coding practices in place ensures efficient patient financial services, and vice versa. If your facility already exhibits accurate patient financial services, but you believe you are still missing out on revenue, you must refine your medical coding practices. Partnering with an expert healthcare support services provider is the best way to ensure you have truly accurate medical coding and a healthy revenue cycle.

ECLAT Health Solutions offers medical coding services that can complement your patient financial services and truly improve your RCM. Our coding experts are trained in ICD-10 procedures and always exhibit HIPAA compliance. We can guarantee a score of 95% or higher coding accuracy in our work. When we work with a client, their revenue goals become our revenue goals, and we work tirelessly to reach and exceed these goals. We are proud to offer this unique approach, which our satisfied customers call “The ECLAT Advantage.”

Make sure you have efficient and accurate medical coding to complement your patient financial services and earn you the most revenue possible. Learn more about ECLAT’s medical coding, medical billing, auditing, and consulting services by calling us at (703) 665-4499, or filling out our contact form!

The Truth About Domestic vs. International Medical Coding

There’s a lot of debate in the world of healthcare about international coding. “Does international coding really save that much money? How safe is it? Aren’t there enough coders here in the United States?”—these are all common questions that healthcare providers ask when addressing their medical coding needs.

There is a lot of misleading information and false rumors floating around that make some providers shudder at the thought of using coders abroad. However, the truth is that international coding is a great model that offers US healthcare providers a multitude of benefits.


Often, the biggest reason many healthcare facilities hesitate to use international medical coding is security. They may fear that looking overseas for coding services means compromising security, and that this alleged increased security risk will outweigh the benefits of a more affordable option. They are, of course, right to be cautious when it comes to their security, but what many of them don’t realize is that international coding does not actually compromise security. International coding providers are well-aware that a security breach would mean a loss of business for their clients, not to mention would compromise patients’ confidential medical records. Because of this, coding providers take extra measures to ensure their clients’—and their patients’—security.

These companies build secure facilities in which the international coders will work. Even though the work is being conducted overseas, an expert medical coding provider will maintain the tightest security measures and ensure that all sensitive information and practices are kept private. As an added measure, most international coding companies will promote transparency and report to their clients about their processes.

An Abundance of Work

The adaptation to ICD-10 procedures in recent years has contributed to draining the pool of qualified coders here in the United States. Healthcare facilities have struggled to spend time and money retraining their coding staff, and many coders who were certified in the former coding practices did not want to learn a brand new set of procedures and left the field. This has created a gap of time in which the newest set of medical coders have yet to be trained and enter the coding workforce, leaving a shortage of US-based coders.

However, there is an abundance of well-trained and qualified overseas medical coders who can meet the demand. International coding companies require their coders to earn the necessary certifications, such as from AAPC and AHIMA, making them just as qualified for medical coding as domestic coders. This abundance of workers overseas also helps keep cost down for healthcare providers without sacrificing quality and accuracy.

Reduced Cost

Outsourcing coding services might seem like a costly endeavor to some healthcare providers, but using international coders is a very financially-appealing option. It’s far more affordable to use an experienced coder from another country than to find, hire, train, and pay a US-based coder who is new to the industry. As mentioned, the abundant pool of candidates in other nations helps to keep costs down, where the smaller availability of coders in the US with a rising demand can end up costing you more than you bargained for.

Partner with the Right International Coding Company

Of course, the key to reaping in these benefits of international coding is to select an expert outsourced coding company. ECLAT Health Solutions offers the most secure, efficient, and accurate international medical coding services. All of our coding experts are well-trained in ICD-10 procedures in addition to maintaining HIPAA compliance. We love working closely with our clients as an extension of their company to help them reach and exceed their operational goals by customizing our services to fit your facility needs. This unique approach is what our satisfied customers call ‘The ECLAT Advantage’.

To learn more about how we can serve you, call us today at (703) 665-4499, or fill out our contact form!

Common Pitfalls You Can Avoid with Effective RCM

Healthcare policies and reforms always seem to be in motion, especially in today’s political climate, making it a challenge for health care providers to keep up. If they can’t adapt to the changing landscape, they miss out on significant revenue. Because the healthcare industry is always shifting and evolving, it’s crucial that your facility’s revenue cycle management evolves with it to maintain cash flow. Implementing effective RCM can also help your facility avoid a variety of common pitfalls. Listed below are some typical drawbacks we would like to highlight for your close attention.

Claim Denials

One of the largest issues plaguing health care providers’ revenue cycle processes is the increasing amount of claims denials. Human error during medical coding processes accounts for a large amount of claim denials. Often, undertrained staff members may select the wrong ICD-10 code while processing a claim, which leads to the claim being denied and means rework of the claim or the health care provider will not be reimbursed appropriately or at all for the patient’s treatment.

The recent increase in healthcare regulation has also led to more and more claims being denied. Insurance companies have been analyzing claims more closely, and organizations like Accountable Care Organizations (ACOs) have doubled down on efforts to reduce healthcare abuse or fraud. This closer inspection of claims, especially when paired with human error and improper ICD-10 coding, has led to a great increase in claim denials, which means health care providers, and their patients, must pay for more medical treatments out of pocket.

It’s important that your staff monitors your facility’s claims process and identifies where errors are occurring as part of your revenue cycle management process.

Delayed or Missed Payments

More and more financial responsibility has fallen to patients receiving treatment in recent years. If this is because inaccurate medical coding lead to a denied claim, the patient may need to pay a hefty sum for treatment that should have been covered. However, even when coding errors haven’t been made, many patients have trouble paying for their treatment, and will need to use credit or a payment plan.

Ideally, healthcare providers should collect patient payments before or immediately after treatment. This concept seems straightforward, but according to a study by Availity, some facilities have found it challenging to collect debts from patients without adding pressure and fear that may lead to dissatisfaction.

Health care providers should promote point-of-service payment collection as part of their RCM to avoid receiving delayed payments from patients. They should also educate patients to ensure they understand the necessary payment for their treatment and cut down on lost revenue.

Failing to Verify Patient Eligibility

Many healthcare providers don’t fully check a patient’s eligibility and insurance coverage prior to providing treatment. In fact, a study conducted by Capario reported that 25% of practices never verify patient eligibility at all. When a provider doesn’t check a patient’s eligibility, there’s a greater chance that the claim will be denied, and the patient is left with an intimidating medical bill. As mentioned, if the provider doesn’t enforce point-of-service payment collection, the patient is likely to take longer to pay, or may dodge paying completely.

Checking patient eligibility during the pre-registration state is a key part of effective revenue cycle management. It’s crucial to verify your patient’s eligibility at the beginning of the process before they make their appointment, not later when you’re trying to bill them for payment.

Repeating the Same Errors

For facilities that see a lot of business and have many administrative tasks to keep track of, it’s easy for the same mistakes to occur repeatedly when processing claims. Putting focus on and processing one claim at a time can keep your staff too close to an individual claim and miss over-arching patterns and errors that are affecting your claim approval rate. To fix this, it’s important that your facility monitors and reviews the entire claims process from beginning to end.

Revamping your revenue cycle management practices so that your facility performs this review will help your staff start to notice common patterns of errors in processing claims. Finding and stopping these errors can help reduce the number of claims that are denied, which in turn means more appropriate revenue for your facility.

Accurate Revenue Cycle Management is Essential

Accurate and effective revenue cycle management is an all-inclusive solution that can keep your facility ahead of the game in the ever-changing healthcare industry and earn your facility as much revenue as possible. To ensure your RCM can keep up with the changing times, you need to partner with an expert healthcare support service provider.

ECLAT Health Solutions can improve your RCM with Medical Coding, Medical Billing, Auditing and Consulting services. We are proud to provide medical coding and billing services to healthcare providers across the U.S.with our highly-trained team of medical coders, we can guarantee a score of 95% or higher coding accuracy in our work. We have a passion for helping your health care facility meet and exceed its revenue goals, even in our constantly evolving healthcare landscape.

Make sure your health care facility’s revenue cycle management can adapt and bring you as much revenue as possible. Learn more about our medical coding and billing services by calling us at (703) 665-4499, or filling out our contact form!

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Effective RCM Can Save Hospitals Millions

A recent report by Advisory Board has found that hospitals are losing up to $22 million in revenue a year because they do not have effective and accurate revenue cycle management (RCM) in place. Advisory Board reported that although hospitals have enjoyed higher profits recently, the focus they have placed on the cost of RCM instead of improving RCM performance has caused them to miss out on millions of additional revenue they could earn.

Although hospitals may believe that spending less on RCM will earn higher revenue, taking the time to improve their RCM process can lead to them earning top-quartile revenue in four key areas:

  • Denial write-offs
  • Bad debt
  • Cost to collect
  • Contract yield

Hospitals that work to create a better patient financial experience can get ahead in these four areas.

As simple as this may sound, a large reason that hospitals miss out on so much revenue is due to human error while submitting patient claims to insurance providers. Before a claim is submitted, if the healthcare provider selects the wrong ICD-10 code for treatment given, the insurance provider may deny the claim, which is crucial revenue that the hospital misses out on.

Accurate Medical Coding and Billing Are Essential

Even though small clerical errors such as a few denied claims might not seem significant, too many of them begin to add up and subtract from a provider’s revenue. Accurate medical coding and billing practices will reduce the amount of denied claims and will ensure your hospital receives the quickest reimbursement possible, which will in turn generate more revenue.

With the potential to earn much more annual revenue hospitals should not take the task of improving their RCM lightly. They must partner with the most effective healthcare support service provider that will help them meet and exceed their revenue goals with accurate medical coding. ECLAT Health Solutions can help your hospital improve its medical coding and billing practices with our accurate and efficient medical coding services!

The ECLAT Difference

ECLAT Health Solutions provides coding, billing, and auditing services to healthcare services across the U.S.! Our unrelenting dedication to helping you meet your revenue goals, our highly trained team of medical coders, and wide range of healthcare support services is second nature.

We make quality our top priority, and can guarantee 95% or higher accuracy in all our coding work. We never stop working to save you money, with our 24-hour turnaround and additional holiday and weekend coverage available upon request. Our satisfied client list includes hospitals large and small, surgery centers, physician offices, IPAs, and many more. Our comprehensive services are streamlined and well-tested, so you can be sure your hospital is in good hands with ECLAT. We have a passion for earning you as much revenue as possible.

Don’t end up missing out on up to $22 million in revenue! Learn more about how we can help your hospital save millions by calling us at (703) 665-4499 or filling out our contact form!