Guiding -vs- Chasing Reimbursement

By Brigit Battaglia

Brigit Battaglia, CAC is Director of Process Design and Optimization at Quick Med Claims. Brigit has deep experience in the areas of process development, AI/machine learning, transportation billing and performance improvement gleaned from 12 years in the EMS billing industry. 

Guiding -vs- Chasing ReimbursementEver heard someone say that something is “like herding cats?” Now imagine you’re chasing those cats in the dark….

We can all relate to feeling challenged by the unknown – especially when it comes to learning about many complex layers of rules and deadlines that often change from one payer to another. You might have experienced the confusion that sets in when these rules are adopted differently from person to person, or department to department – and you may have even learned how easy it can be to get caught up in the chase. It feels wild and frustrating when you seemingly are getting the job done, but are still not collecting the full reimbursement expected.

Now, imagine that instead of herding cats – you’re herding sheep. You can see the open field and all of your sheep. You can see where you were, where you are, and where you are guiding them…but most importantly, you can see where you don’t want to go.

The same can be said for managing Accounts Receivables (AR) – gaining visibility to the life-cycle of your claim is the key to guiding your reimbursement and driving down your ageing. Here are a few examples of how you can start working towards becoming a Reimbursement Shepherd.

  • The Mirror Test

The Mirror Test is an ongoing exercise where a review of your processes can lead to opportunities for improvements. One of the best ways to start is by diving in and learning everything you can about how your top payers process claims. Spend the time on the phone and online learning about the life-cycle of a claim with each payer. What are their processing rules? What are their expectations upon receipt of the claims? What tools do they make available that will create efficiency, while aiding your team in their work? Are you taking advantage of them?

Once you’ve spent time learning about the life-cycle of a claim, you can take some time to assess the billing system you use every day. Are you using it to your advantage? Are there areas for improvement in your processes? Can you mirror the life-cycle of the claim in your own system to stay one step ahead and guide the claim with a proactive approach?

  • Identify your Subject Matter Experts (SMEs )

Advantages are created when leaning into the strengths of your team members. It builds their confidence and understanding of the life-cycle of a claim. Giving space for each team member to become a SME gives everyone an advantage while working the AR. It can be empowering to your team by providing an opportunity to become experts in specialized areas –they then will excel in the work they do each day.

Your SMEs will quickly become your first set of eyes on your AR – they’ll help quickly identify changes that can be made to the current processes – and they will start lending their expertise when performing the Mirror Test. Over time, you might find that you gain the ability to stay current with changes and updates at a payer level and avoid unwanted payment delays and denials. Best of all, you may start to see your ageing reduce and cash collected increase.

  • Creativity in Your Approach

How creative are you willing to be with your approach? Are you following processes that may be outdated, broken, or failed in their attempts? Has the phrase around the office lately been “because that’s how we’ve always done it?” If so, you might be ready to consider getting creative and trying something new.

Taking the Mirror Test and working closely with your SMEs will assist in highlighting where you might want to redefine and redevelop current processes and approaches. When performing these exercises, be bold, take risks – but be sure they are calculated risks. One method could be to test a theory by sending a few claims with your new approach in place to one payer, and then assess the outcome. Was the process beneficial? Was the process efficient? Were delays caused in any other area? Can this be launched to include a larger volume of claims?

Managing the life-cycle of a claim will never be perfect – there may be streams to cross, and mountains to climb that challenge us, but when the Shepherd has good visibility, a knowledgeable team of experts, and commitment to proactive and creative approaches, you’ll find that guiding the reimbursement is far more lucrative than chasing cats in the dark.

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