2014 News Flash: Get It Right Before the Bill Goes Out the Door

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Picture12014 News Flash:  You Really Do Want to Get It Right Before the Bill Goes Out the Door

Doesn’t it sound laudable?  Self-evident?

I dare any hospital patient financial services professional to declare that they don’t want the bill to be correct before it goes out the door.

And achievable when the population of claims is forced through a manual review process, such as the Inpatient claims which need to be coded by HIM.

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When the claim is the result of automated processes incorporating disparate order entry systems, manual orders, links to the chargemaster, late charges … the first time the claim is even available for review is when it comes together in the billing system potentially several days after the encounter.

If you were the CFO, would you hold those claims another day or two to make sure you didn’t miss the $3 venipuncture?

But it’s not just about the $3 venipuncture.  It’s about surgery without radiology (and vice versa), it’s about pharmacy units.  And it’s about the Medicare contractors expanding their prepayment review activity to include Outpatient services.  You might know for several days that you are incorrectly billing the Chemo drug, while the system is waiting for lab charges to come through.

Now do I have your attention?  Here’s the thing.  You can do it all.

Review your charges as they are coming in against each other.  Edit your outpatient claims before they bill, with varying priority levels.  Don’t rebill.  Don’t be denied by MAC or RAC (and choose not to appeal).

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How do you make it happen?  Through SMARTer healthcare analytics.  Through front office access that builds on your existing infrastructure while allowing a window into your disparate systems to achieve better business outcomes.

Lower your rate of denial.  Increase your average outpatient payment.  Lower your AR days.  Lower your rates of rebilling.  Get fully paid, and stay paid, for every service you reasonably provide.

a_440x220Learn more  about IBM Smarter Care, Front Office Transformation and IBM Smarter Analytics solutions for healthcare industry by visiting us at the IBM booth (#1651) at the HIMSS 2014 in Orlando, Florida; February 23-27, 2014. Follow @ibmhealthcare on Twitter to stay abreast of our latest activities and announcements and join #ibmhealthcare conversation. Also bookmark our IBM HIMSS 2014 webpage for updates on our presence. Watch out this space for more interesting blogs on IBM at HIMSS and latest industry trends.


Healthcare Consultant, IBM

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