By Jim Bobeck
If you work in healthcare reimbursement long enough, you’ll notice a major theme. There are a lot of mistakes—missing documentation, lack of signature, basic coding errors, and most importantly, misunderstanding of what’s really needed to prove a claim.
Healthcare reimbursement mistakes compound themselves two-fold. First, through underpayment to providers, suppliers, and related healthcare entities providing good care, which weakens their long term sustainability. Secondly, through an entire monetary recovery system of appeals, auditors, recovery contractors, fraud and abuse specialists, and collection agencies, which adds an even greater amount of cost and complexity to an already Byzantine process.
In short, the feedback mechanism is broken. Every denial is a mistake in some form. Whether a provider or biller submitted incorrect information, the payer applied incorrect policy, or the proper type of care wasn’t provided, there was a mistake.
The claim’s denial provides the opportunity for insight and root cause analysis into how claims should be handled. Questions of documentation, coding, policy, timeliness, and medical necessity can find answers. Through all of human existence, the mistake remains the greatest tool by which we learn. In healthcare reimbursement, it’s no different.
At FHAS, we are working on software-driven, human-focused processes and products to drive healthcare reimbursement and make it work better for all. By focusing on the denials, we have the potential to create better treatment practices. Sustainable care modalities require sustainable payment modalities. When starting to make things better, let’s remember the mistake, which can drive the improvement forward.