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Tuesday August 16, 2022

Pre-Payment Billing Procedures to Reduce Denials

Human error has a serious impact on billing flow. The issue is so prevalent that approximately 80% of medical invoices are thought to be inaccurate.

In this blog, we’ll examine billing flow, particularly pre-payment billing operations, a crucial aspect of revenue cycle management (RCM), and what healthcare systems can do to identify and prevent denied claims.

The Real Cost of Billing Flow Errors

Billing flow errors that result in denied claims affect how quickly a facility is paid. But the additional expenses that result from addressing denials are frequently overlooked.

For instance, appealing high-dollar claims can become complicated and necessitate ongoing negotiation, representing a significant source of lost time and resources.

Preventing denials before they happen is the best way to avoid the cost of lengthy appeals and delayed reimbursement.

Focus on Pre-Payment Billing Procedures

Every step of the pre-billing process must be taken seriously. With careful attention to detail, back-office staff can prevent denials by submitting claims promptly and accurately the first time.

The process of finishing a patient's chart, as well as coding and abstracting, can be considerably and adversely impacted by poor documentation and coding throughout the episode of care. For these reasons, accurately recording a patient's state and the location of service is crucial to generating an appropriate charge and preventing future denials.

Pre-billing procedures that include thorough performance monitoring and insight at every stage are necessary to minimize denied claims and maximize revenue integrity. The majority of these procedures will rely primarily on your team and their capacity for quick and accurate execution.

However, by becoming an extension of your current workforce, a third-party RCM vendor can provide the expertise of patient financial and health information management professionals, who can assist with everything from account follow-up to billing and cash posting.

Real Revenue > Clean Claim Rate

Some RCM consultants encourage hospitals to achieve Clean Claim Rates (CCRs) of over 90%, and many clearinghouses encourage clean claim percentages of over 95%.

True CCR is the proportion of claims that are approved by payors after being submitted to the clearinghouse. This number should be high, given how intricate the scrubber rules are. It does not, however, directly correlate to a low proportion of claims denials and underpaid claims.

The first pass yield, or the percentage of claims that are paid at initial submission and how thoroughly they are paid, is a more useful metric for patient financial services to focus on.

MEDHOST Revenue Cycle Solutions

By supplementing your team with experienced billers, account follow-up specialists, and contract maintenance services, MEDHOST Revenue Cycle Solutions can become a dedicated partner in denial management.

Please contact us at or dial 1.800.383.6278 to find out more about how MEDHOST can assist you with denied claims, analytics, and performance monitoring.

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