By Derrick Stark, CPA, CVA - ClaraVista LLC
I started mountain bike riding about 2 years ago with a buddy of mine. I was amazed at the cost of certain bikes. The guy at the store explained that it had to do with the quality of the components and the ultra-light materials used to shave seconds off the clock. “Oh,” I replied. “I just want to finish the course without throwing up.” Apparently that desire is the difference between a $5,000 bike and a much, much less expensive used model.
The basic ability to complete a task has to exist before it makes much sense to try and get better or faster. Time and again, however, I see providers upgrading software or billing personnel to become more efficient but left with the same disappointing results. Why? Because they were focused on being efficient when they weren’t yet effective.
Start with a most basic of equipment to determine effectiveness; a pencil and paper. Sketch the life cycle of a typical claim from initial inquiry or intake to final resolution. Include every stop along the way. Who completes the initial paperwork? Who runs down missing information? Who transmits claims and works front-end rejection reports? Who manages denials? Who makes sure payments and denials are posted timely and accurately?
I bet you will find that most things fall through the cracks because they make their way to an area for which no one has specific responsibility to follow up. That is, it is not that your current software cannot flag or report these items. It’s not even that your billing personnel were incapable. It’s that no one knew to be on the lookout for the claims that never made it to the next station.
Once claims are reliably reaching a final resolution, then and only then, is it worth shaving seconds off the clock.