At the beginning of the article “improving cash flow with better charge capture and denial management” they have said that undergoing a surgery without any anesthesia is probable to happen and I think that it is a good way of catching the public’s interest in reading the said article. However, the most important thing to consider in the article is the fact that many hospitals lost a lot of money due to poor management of their billing process. One of the primary reasons for this loss is undercharging as well as sending various claims which the insurance carrier would view as imprecise and thus the claims would then be denied.
Claim denials as well as neglected items are caused primarily by employees who had not been properly trained and in some cases the blame could be put on poor technology. Thus, it is important to know the main source of the billing problems in order for the management to know what means to use in fixing it. For example, if the problem had been primarily caused by untrained employees then it only makes sense for the management to introduce a program where their employees could be properly trained. Denied claims could cause a serious trouble and thus the CFO’s should not take the issue lightly.
Denied claims caused by mismanagement could lead to a great loss in revenue as well as additional costs made by reprocessing denied claims. Although the impacts of denied claims on some hospitals were not as shattering as one expects they still consider it a must to manage denied claims. The reason why the damage caused by unpaid drugs and the like are not so significant for hospitals is that their services are usually paid not on their actual charge but rather they are paid based on diagnosis-related group.
However, some hospitals were not as lucky such as Chelsea Community Hospital because for them denied claims could cause such a shattering impact. Missing OR’s as well as unpaid medical procedures are very common because of technological error as well as poorly trained staffs and thus many hospitals lose as great deal of their revenue. Seeing the effects denied claims as well as poor management could havoc then it is only necessary for these hospitals to be more alert knowing very well how prone to error their billing management could be.
Since the billing problems are often undetected the management should make it a must to often check with the system as well as on their employees. Practice management is very important on hospitals because their business is comprised primarily of the everyday operations of every hospitals thus errors made on practice management must be avoided by all cost. Errors made on reports as well as on billing process could be a major lost on hospitals revenue. As I have mentioned earlier employees who had not been trained properly could contribute a great deal on hospital loss.
However, firing an employee as soon as one already learned of his or her mistake is not advisable because the hospital may end up lacking on man power thus, the right thing to do would be to help a mediocre employee be an excellent one. One could either help the employee by providing him with great feedbacks if he or she did something good and you could also provide him a good example as well as a proper training. To conclude, problems regarding practice management could not be avoided however, it could be lessened.
Helping a mediocre employee would be a great means in doing so. Data problems could occur in the process and thus understanding the data variations would also help you a great deal in avoiding billing problems as well as problems caused by denied claims. A thorough checking on your employees and technology is also a must. One should bear in mind the losses mismanagement could cause and thus in order to cure those losses one should first determine the causes of the problems and work it out from there.