Advanced analytics can greatly reduce data-entry errors in medical coding.In recent years, specialty practices have shifted from reactive healthcare, toward more preventative medicine as a means to treat patients more effectively, and at lower costs. This trend is especially apparent in value-based care (VBC) and accountable care organizations (ACOs). The theory is sound: Why wait for patients to come to you with a serious problem when you can take proactive measures to increase the likelihood of a desirable outcome? Clinically speaking, mitigation is less complicated and generally more effective than remediation.

The same can be said for a healthcare organization's operational and administrative workflows. Practice management was traditionally about how a healthcare provider responded to patients. Today, though, it should also be about taking active measures to increase patient engagement, improve critical revenue opportunities, and enhance overall practice efficiency.

Thanks to improved data-sharing throughout the healthcare industry, specialty practices now have access to powerful data sources and reporting capabilities that can improve revenue and provide tremendous insights into operational dynamics that, earlier, were out of reach of most independent offices.

Here are four ways specialty practices can start using greater access to data to facilitate intelligent workflows, robust revenue streams and improved healthcare outcomes:

1. Eligibility Verification

Failure to verify a patient's insurance eligibility prior to rendering services creates undue financial risk for a healthcare organization. Patients benefit details can help you properly collect the lion’s share of your practice’s revenue and, therefore, eligibility verification should be a top priority for every healthcare organization. It's easy money compared to trying to retroactively collect a bill from a patient who has to pay out of pocket.

Calculating your expected revenue from insurers is also an important facet of revenue cycle management. If you know with confidence what percent of your outstanding accounts receivable value is expected to come from insurance companies, and what percent is in billing collections, you can more effectively measure RCM performance and overall financial health.

So, how do you optimize eligibility verification? Automate it. According to Becker's ASC Review, healthcare providers could collectively save an estimated $9.5 billion by managing claims submissions electronically. Step one in this process is to leverage a practice management tool that automatically verifies a patents' insurance coverage. This eliminates an otherwise time-consuming process from your operational workflows. More importantly, it increases the likelihood that you'll get paid for your services, and it facilitates transparent RCM.

2. Claims Scrubbing

Speaking of claims, all it takes for a submitted claim to be denied is a single typo or an inaccurate code. It's difficult to estimate the dollar value of denied claims that result from something as simple as mistakenly entering the wrong age for a patient. What we do know is that some $262 billion worth of claims are rejected every year, according to Modern Healthcare. We also know, per Medical Billing and Coding Online, that the majority of denied claims are data-entry errors. Therefore, we can safely say that the amount of missed opportunity costs from rejected claims is in the hundreds of billions.

There are several effective ways to reduce claims denial rates that stem from errors:

  • An online patient portal: Data is extraordinarily useful, but only if it's up-to-date. With an online portal, patients can continually update contact information and other key data that will be included in claims.
  • Assisted coding: Integration between your practice manager and EHR system will help preempt coding errors by automatically associating certain treatment key phrases to specific CPT codes.
  • Automated claims scrubbing: Last but not least, should any information included in a claim not align with coding rules, whether National Correct Coding Initiative (NCCI) or custom payer-specific, an intelligent PM tool will automatically flag the potential error to allow pre-submission corrections supporting a higher clean claim rate.

Coding is extremely complicated and historically time-consuming, but it's a necessary evil. You can't eliminate the process, but you can drastically improve it with smart claims-scrubbing and coding-assist technology.

3. Patient Cost Estimations

The recent rise of high deductible health plans (HDHP) have now positioned patients themselves as healthcare’s third-largest source of revenue (some studies have placed patient payments at #2…). What’s problematic about this is that, once patients leave the office, the chances of them paying their portion of the claim declines by 40 percent, per data from Becker's ASC Review.

Underscoring the impact of this issue was Black Book’s 2017 RCM Survey, which found that 83% of practices with five or fewer providers regard the “slow payment of high-deductible plan patients to be their top collection challenge,” followed by the difficulties that staff have at explaining payment responsibilities to patients (81%).

Clearly, not collecting patient payment before rendering services not only constitutes a threat to a practice’s revenue goals, but also to their overall bottom-line, as more (costly) overhead must be dedicated to post-encounter collection efforts.

The most effective way to prevent these problems is to use a data-driven payment estimation process prior to the visit. A practice management system that links up with health insurance companies' data services can quickly process each patient's eligibility. Such a system can help project the costs upfront, based on the reason for the visit, but also in accordance with eligibility and benefits. Patient payment responsibilities (e.g. co-payments and upfront costs) are subsequently more accurate – and collectable – at the time of the visit.

4. Better Communication with Patients

Coding, billing and claims processes aren't the only administrative functions that benefit from advanced healthcare analytics. Healthcare providers can also use a modern practice manager to automate communication with patients.

Practices can use such a solution to queue up patients to replace last-minute cancelations, each of which would otherwise cost the practice at least $200 in missed revenue, according to Health Management Technology. A patient waitlist solves this problem by alerting staff of those who have expressed interest in earlier appointments and facilitating a more seamless and efficient re-scheduling process.

Even before a cancelation occurs, a reliable practice management solution sends automatic appointment reminders via the patient's preferred means of communication, such as phone or text messaging. These settings can be changed or updated at any time, either on the practice's end or through an online patient portal.

5. Data-Driven Medical Interventions

In that same vein, data-driven medical interventions are a key area where the clinical half of the practice overlaps with the operational side to truly improve personalized healthcare. Also known as population health management, these timely interventions can be as simple as sending an email to a chronically ill patient every few months to ask them to provide an update on any new symptoms they may be experiencing. Should that patient in fact provide that update, your front desk staff can reach out and inquire about scheduling an appointment in the near future.

This heightened level of patient engagement leads to more personalized, effective healthcare and can help providers take action before a potential problem becomes serious.

All of the above are just some of the ways that data, analytics and automation - when applied to the operational and administrative side of healthcare - are a win-win for speciatly practices and patients alike. To read about some of the other ways that today's newest practice managers can enhance financial stability and patient care, click here or Contact AllMeds today.




Advanced analytics can greatly reduce data-entry errors in medical coding.

AllMeds Specialty Practice Services

Advanced analytics can greatly reduce data-entry errors in medical coding.

AllMeds Specialty Practice Services




Advanced analytics can greatly reduce data-entry errors in medical coding.

AllMeds Specialty Practice Services

Advanced analytics can greatly reduce data-entry errors in medical coding.

AllMeds Specialty Practice Services