It’s an all too familiar scenario. Your revenue cycle manager enters your office to ask why your cash is decreasing, yet patient visits and billing numbers indicate no decrease in the number of services provided or billing. You review Accounts Receivable (AR) and identify the problem: a delay in various payments by an insurance provider. Payment delays occur when a payer or insurance company rejects or denies a claim. A payer can reject a claim due to claim formatting issues, demands for additional paperwork, or an incorrect standardized medical diagnosis code. Payers can also deny the claim if the patient did not receive authorization from the payer to receive a service. Payer rejection or denial is typically the result of inadequate or neglected communication between a care provider and a payer prior to billing. As a result, your team scrambles to get corrected claims out the door, change condition codes for future forms, and expedited form corrections to ensure payment. While the immediate fire is put out, how do you prevent incorrect claims from being sent in the next billing batch? Your Electronic Medical Record (EMR) software needs to quickly communicate the payer status, enable the alteration of future forms according to payer requirements, and pivot to meet new demands.
Understanding EMR Software
Let’s take a step back. In 2009, the American Recovery and Reinvestment Act (ARRA) required the adoption of EMR systems to best serve patients. EMRs are electronic medical files in which doctors store personal medical records (PMR), diagnoses, and other patient information. This information is utilized in record maintenance, prescription, payroll, claims, billing, and more.
The Need for Advanced Solutions
The unfortunate truth is that patient care is dictated by payers and insurance providers. Payers are experienced, meaning they have the ability to tactfully maneuver around federal and state guidelines while also holding the power to define acceptable payment and documentation.
You deserve to be paid for the services you provide. Leveraging an EMR which demonstrates responsiveness to sudden changes and communicates those changes enables you to anticipate and mitigate them. Implementing an unresponsive EMR results in piling payer rejections, increased AR, decreased cash, and time spent managing documentation rather than focusing on patient care.
Pivoting During Sudden Changes
An EMR needs to be flexible and adaptive. Your system should:
- Alert users if any information is changed, claim format requirements are changed, a payer rejects or denies a claim, or if other issues arise. Communicating the problem facilitates a rapid response.
- Enable the alteration of documentation and new forms to respond to new state regulation and payer-specific format requirements.
- Document an audit trail for each patient from intake to payment.
EMR software need to provide efficient data management and accurate, traceable information in order to effectively respond to sudden changes.
Finding Your Ideal EMR Software
KanTime offers web-based management software that responds to challenges in-home, pediatric, private duty, and hospice healthcare. Our software includes a custom payer checklist designed to ensure the completion of mandatory items prior to accepting a client, preventing potential claim denial or rejection. We also automate assessments of Medicaid eligibility to prevent the issuance of claims for ineligible patients. By optimizing processes from patient intake to billing, KanTime not only pivots according to sudden changes but predicts and prevents their occurrence. To learn how KanTime’s EMR software can help you pivot to unforeseen challenges, get connected with our team today.