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Happy Summer! At ClinicSpectrum, we’re welcoming the longer days and warmer weather.
This month, our newsletter focuses on three challenges our clients face daily: eligibility checking, AR follow-up and denials management. Our client Union County Cardiology Associates, a physician’s practice located right in our backyard of Union, NJ, shares their story of how our hybrid workflow model has allowed them to complete the sometimes lengthy follow-up process to recoup funds from patients in a much more efficient manner.
Eligibility checking is the single-most important factor in avoiding insurance claim denials and a lengthy follow-up process. With deductibles continuing to climb, and 80-90% of health plans relying on deductibles, the onus now falls more heavily on the patient to pay for care out-of-pocket. Therefore, physician’s practices must be cognizant of checking a patient’s insurance status before providing care.
Successful eligibility checks subsequently make the AR follow-up process much easier. However, even if you are proactive about eligibility checking and AR follow-up, a small percentage of denials are inevitable. By using our unique hybrid workflow model, our customers avoid high denials rates and settle bills faster.
Read on to learn more about how our system has been put to use at Union County Cardiology, eliminating headaches one claim at a time.
As always, we appreciate your feedback. Please reach out if you have comments or suggestions for our newsletter.
Union County Cardiology, a practice with four physicians, currently uses our full suite of patient collection tools. Administrator Nelly Gamboa has been using the products for xx years and has had nothing but positive results, “ClinicSpectrum’s eligibility checking solution saves significant time, allowing me to focus on other projects. I don’t even have to think about eligibility—all of our patients are confirmed to have insurance prior to their appointment, which considerably cuts down on A/R follow-up and denials management.”
For a practice that deals with thousands of claims each year, time is incredibly important. While it used to take an average of 30 minutes to process a single claim, Nelly says that it now takes only 10 minutes to process.
Understandably, since implementing ClinicSpectrum’s hybrid workflow model, revenue has gone up 30% for Union County Cardiology. The combination of all three solutions, eligibility checking, A/R follow-up, and denials management, has made the process seamless. Nelly relates, “ClinicSpectrum scrubs up the claims so minimal interaction is needed by administrative staff.”
Does your practice employ the single most effective strategy to prevent insurance claim denials? ClinicSpectrum’s Eligibility Checking Service has saved our clients up to 25% percent in revenue.
We begin by retrieving a list of upcoming scheduled appointments and verifying insurance coverage for all patients. Once the verification is complete, coverage details are put directly into the appointment scheduler for the office staff’s notification.
We then utilize three methods of eligibility checking:
• Health plan websites or payer portals• Automated voice• Personal calls to insurance company representatives, if necessary,to obtain a detailed benefits summary.
This process helps us to provide a comprehensive picture of each patient to our clients, ensuring accuracy.
On the opposite end of the spectrum, should a physician’s practice require assistance in follow-up for payment, we also provide an Accounts Receivable Follow-Up Service. There are a variety of reasons for which a claim might not be approved, and our role is to remove the burden from the physician’s practice by engaging in the time-consuming AR process.
We begin our follow-up efforts 10 days after an electronic claims submission, and 20-45 days after a paper claims submission. ClinicSpectrum is able to support both no remark and last remark claims.
We employ the same three step process utilized in eligibility checking in our AR follow-up: verification through health plan websites or payer portals, automated voice or personal calls to insurance company representatives, if necessary, to obtain a detailed benefits summary.
Denials Management is the final part of the claims follow-up process. We provide follow-up support for two types of denied insurance claims:
• Correction and Resubmission – These are claims that need to be adjusted and modified before being sent to insurance companies for a second time. This process ensures that we do everything we can to ultimately avoid billing the patient incorrectly.
• Patient’s Responsibility - Unresolved claims are generally only sent to the patient when the claim is indeterminable due to non-covered benefits or in-network deductibles, which vary based on a patient’s own plan or policy. The statements sent to the patient will note and explain the reason for having an outstanding balance. We do whatever we can to avoid billing the patient directly by using our meticulous process for each client.
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