The health of an organization’s revenue cycle depends not only on the accurate performance of employees in their respective roles, but also the understanding of how their roles impact others up and downstream, and therefore the quality and speed with which a claim gets processed.
One area that has incredible impact on a claim’s processing is coding, and yet many back-end staff, those who are tasked with resolving denials and other claims processing issues, have little knowledge of codes or their importance. Teaching staff what codes are and how they impact the way a claim is paid per your organization’s contracts will give staff useful information on why they do certain tasks in their day-to-day jobs, and may help expedite issues with denials and recodes.
I spend a significant amount of time in our Managed Care Account Resolution workshop teaching staff about what codes are and how they are used to calculate the expected reimbursement due from the payer. We then take that knowledge and kick it up a notch by pricing claims by hand using a standard contract rates sheet for HMO and PPO products, and continue to build understanding by identifying underpayments and including the necessary allowable calculation in appeal letters. This understanding gives resolution staff greater confidence when arguing allowables on the phone with payers as they can calculate the expected rate themselves and even use their new understanding of codes to do some sleuthing and discover which rates the payer must have used when calculating the underpaid amount. Armed with this knowledge, they are primed to make their follow-up calls and appeals more effective, saving precious dollars for the organization.
Reach out to learn more about the learning opportunities HBI can offer your staff to increase knowledge, engage staff, and increase your bottom line.