covid 19

Denial Management in the Time of Pandemic

Health crises such as COVID-19 pandemic are putting a strain in the healthcare system. In the lens of health insurance, policy cancellations add a different level of burden. While the government has support implementations such as Coronavirus Aid, Relief and Economic Security Act funding in helping businesses retain employees, there is still an expected increase in policy cancellations as a result of unemployment and the overall economic downturn.  It is also uncertain as to whether the government will provide relief to the insurance industry.

Despite the increased insurance cancellations, health insurance companies are taking the toll on paying for expensive tests and treatments for those policyholders that have COVID-19 coverage. According to American Academy of Actuaries, insurance companies without large cash reserves could have problems because of expenses related to COVID-19 care and the widespread waiving of cost sharing, including for treatment. It is then very important for insurers to have accurate medical coding and billing processes to avoid mistagging insurance coverage and making sure that cash flow is managed correctly.

Although the US administration declared a national emergency by granting HHS authority to waive certain Medicare, Medicaid and CHIP policies, pandemics are a phenomenon that not all health insurance companies have prepared for. There will be confusions over what the blanket waivers do insurance policies cover in an attempt to manage health crises with a finite amount of resources.

To track the spread of coronavirus and get paid for testing and treating, having accurate billing and coding processes are the key in helping providers in overcoming the challenges of a pandemic now and in the future. Also, having accurately coded medical procedures streamlines communication across the health system and reduces administrative rework decreasing costs at a time especially with the scarcity of resources. Prior to the pandemic, health insurance companies are already facing high volume of claims and billing errors. When the economy reopens, there will be a definit surge in medical claims and billing.

But since this is a new health crisis that health insurance companies are facing, some treatments and procedures will fall under the denial management system.

How, then, can you effectively manage denial claims in times of crisis?

Understand how and why claims are denied at the first place

Knowing why claims were denied is important in streamlining your process to maximize your collections revenue and preventing future denied claims from happening. Since most if not all of the patients are knowledgeable about the insurance denial system, it is your job to educate them on how they can solve the issue. But you can only do so if you and your team members are aware of the reasons for denied claims. This will also give you an avenue to create action plans on organizing and creating a system in place to keep track of your denials. 

Many health insurance companies and hospitals are adopting tools and technologies in assisting them in tracking the ‘when’ and ‘why’ the claims are being lost in the shuffle. This will help your company in managing denials and keeping an eye on which ones still need attention in the best way to maximize denial collections revenue. Keeping track of denied claims will help you see which areas in your denial management process are working and which need further support. Documenting both wins and losses, in regards to your unpaid claims helps in improving the efficiency of your organization and sticking close to the analytics in your strategy in denial management.

Identifying common denial trends and updates in medical codes

Being aware of the common denials is a crucial component of establishing an effective denial management process. Although each health organization may have a unique list, there are top causes for coding and billing denials common to every health insurance company which are; Coordination of Benefits, PIP Applications, Accident Details, Pre-existing Conditions, Name Misspellings and new emerging illness and diseases.

These denials may seem like a small problem initially but with continued tracking and analysis it may reveal larger issues within your health insurance company. Creating a system in the denial management strategy of your organization helps ensure that these problems are addressed on the set and also creates foresight for trends five years from now. Plan ahead, and you may see your list of common denials start to lessen. 

Being updated with the new codes in enabling COVID-19 tracking and billing can help in capturing testing and treatment claims. CDC announced in March that it has added the new International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) emergency code created by the World Health Organization earlier this year. According to official guidance from the CDC, health insurance providers should only use U07.1 to document a confirmed diagnosis of COVID-19 as documented by the provider, per documentation of a positive COVID-19 test result, or a presumptive positive COVID-19 test result. Being aware of these updates and codes also helps in decreasing denied claims.

Outsourcing denial management process and team

It is then very crucial for health insurance companies to minimize their operational cost and secure accurate medical coding and billing processes to avoid mistagging of insurance coverage and making sure that cash flow is managed correctly especially in the midst of the recovery phase caused by the pandemic. Having a team of reliable and experienced medical coders, billers and claims processors who are crucial to accurately translate patient data into alphanumeric codes and properly tag which treatment and tests are covered by the insurance plan to make sure that the medical expenses are accounted for correctly and accurately. 

Partnering with a reputable & trusted outsourcing company that specializes in Revenue Cycle Management services and has expertise in denial management. Top denial management providers build great teams of highly trained billers and coders that are working with, negotiating and navigating the complexities of the insurance system. By outsourcing your denial management tasks, you’ll have more time to focus on the core areas of your business that require your attention. When choosing which outsourced company to partner with, there are two questions you should ask:

  1. Will they ensure exceeding customer satisfaction?
  2. Will their claims management assistance refute denied claims and increase cash flow?

Expanding other non-clinical related concerns such as medical billing, coding, claims and health insurance processing by partnering with an outsourcing company that is an expert in the Revenue Cycle Management (RCM) process who can provide these extended services virtually can be one of your key weapons in keeping your healthcare business afloat. This team can help in accounts receivable management including follow-ups of unpaid claims and resolution of denials. They can also take care of filing claims to health insurance carriers, post payments received, send patient statements and stay updated with the trends and changes that may affect client’s reimbursements. This results in >95% claims accuracy, 1 hour turnaround time and minimal to none denied claims by getting it right the first time.

At Infinit-O Global, we build great teams of medical billers, medical coders, clinical and medical abstractors that resolve claims denied by medical insurance carriers, stay up-to-date with the changes that affect client’s reimbursements and understand how the medical insurance industry works. Our aim is to create long lasting partnerships and endless opportunities for your business to grow on top of saving at least 70% on operational cost. We render a strong combination of business consultancy, process optimization, and outsourced services; all utilizing the latest technology to provide excellent value for our clients. We are ISO-certified, HIPAA– and GDPR-compliant, so your company and data are safe with us.

Infinit-O Global’s aim is to create long lasting partnerships and endless opportunities for your institution to grow while managing the sudden demand for healthcare. We render a strong understanding in medical review and analyzing clinical abstractors for health institution consultancy, process optimization, Revenue Cycle Management (RCM) process and outsourced healthcare services; all utilizing the latest technology to provide excellent value for our clients.

Let’s work together to Build a Great Denials Management Team.

2 months ago No Comments Views

Flatten The COVID-19 Curve Through Telehealth

Historically, healthcare is immune to business vulnerability during a recession because there will always be a constant need for care and treatment as illness and diseases happen with or without crisis. Hence, the demand for healthcare is relatively constant across a business cycle. However, some crises such as a pandemic have a different tale to tell. Implementations such as physical distancing and lockdowns to reduce the risk of virus spread has affected the mobilization of healthcare across the country and across the globe and health care offices are feeling the pinch.

Not a single company in healthcare is not at risk for business vulnerability in any type of crisis. Especially with a health-related crisis, the bulk of the responsibility is carried by the providers of clinical care. If this won’t be contained and the curve of spread doesn’t decrease through time, the effect of a crisis upon the health and care system poses a vulnerability in the industry and goes beyond economic concerns.

telehealth

As of this writing, the COVID-19 pandemic has reached 3.51 millions cases with over 248,310 deaths and 1,156,991 recovered individuals. The US is now top one in terms of number of infected people, higher than China where the virus first spread. In only 2 months, China was able to flatten the curve of infection through aggressive testing and quarantine efforts. Another country that successfully flattened the curve of the pandemic is South Korea by preventing and delaying the spread of virus so that large portions of the population do not get sick at the same time. These countries were able to stamp out COVID-19 as soon as possible through:

  • Quarantining
  • Encouraging physical distancing
  • Encouraging working from home
  • Closing schools and other institutions
  • Placing hard limits on the size of crowds at events

Without treatment and vaccines available, physical distancing is about the only key to limit the spread of the virus. Reopening businesses and other non-essential commodities when physical distancing measures are in place throughout the country can halt in flattening the infection curve. Yet, enhancing and mobilizing the healthcare industry through telehealth into adapting to the new normal is one key measure to control and limit the pandemic. Now, what is telehealth and how does it help in flattening the curve? 

Telehealth is a virtual platform that allows healthcare interactions such as promoting long-distance clinical health care, patient and professional health-related education, and public health and health administration. The number one job for everyone is to avoid being a carrier or a distributor of the virus. Therefore, virtual healthcare such as telehealth can free up medical staff and equipment needed for those who become seriously ill from COVID-19 especially the people with greater risks like 60 years old and over, children, individuals with underlying health conditions and those with compromised immune systems. Keeping people apart and not congregating in small spaces such as clinics and hospitals can thwart the virus to roam from one person to another or as we all know as physical distancing. But keeping healthcare professionals apart from patients is called medical distancing and can be accomplished through telehealth.

How then can it flatten the curve?

Think of it this way, suspected and probable patients can stay at home and treat the flu-like symptoms instead of going to the hospital. Aside from the influx of patients in and out the hospital, staying at home can limit the spread of virus that can possibly  infect medical frontliners. But of course, these people still need ample treatment from professionals. This is where telehealth comes in. Through the use of video chat or phone call, medical providers can call in to assess and gather information to find out whether care is urgently needed, or self-monitor of symptoms at home is more advisable. It can also be used for regular check-ins during recovery, as needed. 

Sad but true, there are more than 100 healthcare professionals per institution under quarantine because they face head on and are exposed to infected people which in return raises concern on workforce capacity. If the spread will not be managed sooner, it will come to a point that supply of healthcare professionals will not meet the overwhelming demand. 

Another beauty of telehealth is balancing the load through disseminating the needed care to thousands of online clinicians. This helps medical facilities struggling to better serve patients during peak periods of the outbreak. Through telehealth, those under quarantine may still extend a helping hand through virtual check ups and consultations freeing up clinicians in performing in-person care.

While the number of outbreaks is spiralling, the need for healthcare does not exempt those people with high risk non-COVID-19 related illnesses such as cardiovascular diseases, hypertension, diabetes mellitus and cancer. Telehealth can come in handy beyond treating COVID-19 related cases by providing options to other routine care to the elderly and other high-risk patients. This is a calculated strategy to protect non-covid related patients from exposure while not limiting routine care. Limiting their exposure in the waiting room, emergency room or at the doctor’s office promotes decreasing their risk in contracting the virus especially since these people are more often than not immunocompromised.

Now if there will be an increased use of telehealth, what’s next?

If most health institutions use telehealth there will be a significant surge for online waiting queue and virtual healthcare providers may get overburdened. Streamlining up-front screening questionnaires, chatbots, and AI tools aid in making health processes and patient encounters more efficient for clinicians. The strategy of getting patient information while on hold helps practitioners by having already available data about medical history, symptoms, and other information needed to accurately diagnose.

It is also important to partner with an outsourcing company that can provide a team of healthcare professionals who can help manage the patient influx from this outbreak with the best healthcare practices at hand. The right outsourcing company can catapult the healthcare industry amidst the crisis by helping get clinicians working as quickly as possible where they’re needed most and at the same time targeting key metrics such as quality improvements in telehealth, decreased turnaround time for claims management, savings operation cost and most importantly access to the right pool of talents in the telehealth field – all while adhering in keeping health risks low through the beauty of being able to perform administrative tasks and support despite geographical distance.

Here at Infinit-O, we understand the impact of telehealth’s contribution in flattening the curve of this pandemic. Operational support and Revenue Cycle Management (RCM) support such as patient concierge, medical review specialist and other patient inquiry-related needs to back up production capacity and freeing clinicians from answering phone calls and responding to appointment inquiries. They can also help oversee the day to day peer review process from acceptance of medical cases for review, facilitating first level screening if applicable and preparation of case review documents to be endorsed to doctors, nurses and other healthcare providers.

We build great teams of registered nurses, clinical data processors, patient engagement specialists, medical coders, certified medical billers for claims concerns, clinical and medical abstractors among others. Our aim is to create long lasting partnerships and endless opportunities for your institution to grow while managing the sudden demand for healthcare. We render a strong understanding in medical review and analyzing clinical abstaractors for health institution consultancy, process optimization, and outsourced healthcare services; all utilizing the latest technology to provide excellent value for our clients. 

We are ISO-certified, HIPAA– and GDPR-compliant, so your company and patient data are safe with us. HIPAA-compliant companies can provide telehealth services during state emergencies and can transmit any health information in electronic form.

By expanding consultation services and other health related concerns such as billing, claims and insurance through telehealth in partnership with an outsourcing company that can provide these extended services virtually can be one of the key weapons in flattening the infection curve. Having an organized health triage system aids the existing burden that in-person clinicians are shouldering.

Let’s work together in Building a Great Telehealth Team who can duly respond with the expanding healthcare needs.

Start small. Exceed expectations. Think infinitely. Think Infinit-O.

2 months ago No Comments Views

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