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 for a wide range of reasons, including 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 usually boils down to 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 expedite 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 must be able to do three things: 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) was introduced, which required the adoption of EMR systems to improve quality of patient care and better protect their medical information. EMRs are electronic medical files in which doctors store personal medical records (PMR), diagnoses, and other patient information. This vital information is utilized in record maintenance, prescription, payroll, claims, billing, and more.
The Need for Advanced EMR Software Solutions
The unfortunate truth is that patient care is dictated by payers and insurance providers. Payers can tactfully maneuver around federal and state guidelines while also holding the power to define acceptable payment and documentation.
Providers deserve to be paid correctly for the services they provide. Leveraging an EMR that demonstrates responsiveness to sudden changes enables you to anticipate and mitigate them to keep your operation running smoothly. Implementing an unresponsive EMR can result in accumulating payer rejections, increased AR, decreased revenue, and time spent managing documentation instead of focusing on patient care.
Pivoting During Sudden Changes
An EMR needs to be flexible and adaptive. Your system should:
- Alert users about significant events such as information changes, claim format requirement changes, payer rejections or denials on claims, and other issues. Quickly communicating the problem facilitates a rapid response.
- Enable documentation alterations and custom form creation to respond to new state regulations and payer-specific format requirements.
- Document an audit trail for each patient from intake to payment.
- Provide efficient data management and accurate, traceable information.
Finding Your Ideal EMR Software
KanTime offers web-based management software that effectively responds to challenges in-home, pediatric, private duty, and hospice healthcare. Our software includes a custom payer checklist designed to guarantee the completion of mandatory items prior to accepting a client, which helps prevent potential claim denial or rejection.
KanTime also automates assessments of Medicaid eligibility to prevent the issuance of claims for ineligible patients. By optimizing and streamlining 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 easily pivot during unforeseen challenges, connect with our team for a demo.