Managing healthcare claims is an ongoing challenge for providers and organizations alike. However, it shouldn't be too complicated or burden your team with unnecessary administrative burdens. Let’s take a closer look at how to make healthcare claims management more efficient and produce better outcomes, especially for those in the behavioral health field.
Incorporating EHR Into the 5-Step Revenue Cycle Management Process
An electronic health record (EHR) can significantly impact every step of a revenue cycle, from coverage verification to payment in full. Here, we’ll examine the steps involved in implementing healthcare claims management, particularly in behavioral healthcare. We’ll also show how an EHR system with key features can simplify the claims process, enhance efficiency, and reduce errors.
Initial Patient Information and Eligibility Verification
Healthcare claims management starts with documenting patient information, which is especially critical in behavioral healthcare. Here, you often need prior approval from health insurance companies before setting an appointment. The process involves getting a referral, recording the patient's demographics, and recording their current and past medical histories.
A 2022 American Medical Association survey found that among doctors, 88% characterized the administrative burdens from precertification as “high or extremely high.” Clinicians also indicated that the lengthy pre-authorization process sometimes delays patient care, resulting in negative clinical outcomes.
A comprehensive EHR system simplifies this process with patient registration and eligibility verification tools. Features like these enable healthcare providers to quickly validate insurance coverage and ensure that patients meet the criteria for their specific treatment plans.
Moreover, patient-centric self-service features like contactless check-in, self-scheduling, and online communication tools can help streamline the process, reducing administrative burden and improving the patient experience.
Documentation and Coding
Accurate documentation and coding are necessary components of successful medical claims management. Providers must meticulously record detailed clinical notes, treatment plans, and diagnosis codes that adhere to industry standards and regulations.
Intuitive features of the right EHR solution improve manual documentation workflows by saving valuable time and reducing the risk of human error on insurance claims. Medical service providers can use an EHR system to simplify critical processes in this area. With built-in templates and customizable forms, providers can capture and organize patient information more efficiently.
One such healthcare claims management feature is automated coding assistance. As providers input information into the system, the EHR intelligently suggests appropriate diagnosis codes, ensuring compliance with coding standards. As a result, coding is more efficient, and coding errors are less frequent, helping