From processing 12 medical bills per claim on average to having 32% of bills rejected, efficient healthcare claims management can be challenging, repetitive, error-prone, and extremely manual. Medical claims adjusters spin many plates: they have to ensure healthcare providers are reimbursed accurately and promptly, while also handling complex claims, ensuring positive outcomes for their clients, reducing turnaround time, lowering charges, and so much more.
To overcome the challenges a modern medical claims adjuster faces, a comprehensive medical bill verification solution is required to not only help their insureds but simplify processes for internal employees.
Incoming Medical Bills Require Manual Reviews for Adjudication
The time-consuming task of manually reviewing and adjudicating incoming medical bills is a huge challenge in medical claims management because parsing through the often lengthy pages of bills and medical records requires significant human effort. However, a cutting-edge medical bill verification solution can alleviate this clunky process through the implementation of advanced auto-adjudication capabilities like those seen in Ventiv Verify. By using technologies such as machine learning and artificial intelligence, these solutions can rapidly analyze medical bills accurately–effectively automating the process of determining eligibility, coverage, and payment amounts.
An automated adjudication process accelerates the claims processing cycle and minimizes the likelihood of errors that lead to claim denials and delays.
Claims Life Cycles Are Too Long
A lengthy claims closure time can have significant implications for both providers and payers, so timely processing of claims is a must for medical claims adjusters. Expediting the entire claims management from billing to closure can be automated with a comprehensive medical billing solution. By using a medical billing solution like Ventiv Verify to automate routine tasks, such as data entry and validation, and provide real-time status updates, healthcare billing software enables healthcare organizations to reduce claims closure time substantially. Faster claims closure not only enhances overall operational efficiency, but also improves cash flow.
High Provider Bill Charges
The high cost of claims processing is often overlooked in healthcare, but Ventiv Verify’s medical bill verification software can greatly minimize the costs associated with claims processing. By implementing pre-built business rules and intelligent algorithms, this software can identify opportunities to optimize reimbursement rates and reimbursement opportunities–allowing claims adjusters to negotiate favorable terms with healthcare providers.
Research has shown that a well-implemented medical billing solution such as Ventiv Verify can result in a reduction of provider billed charges by up to 18%, creating significant cost savings.
Manual Efforts Reducing Adjuster Efficiency and Productivity
Claims adjusters are vital in the claims management process, but the manual review of stacks of data takes time, and it’s very easy to make mistakes. However, by introducing Ventiv Verify’s groundbreaking features such as document image tagging, Optical Character Recognition (OCR) document data capture, and medical bill indexing scores, manual efforts can be substantially minimized. These technologies enable adjusters to quickly and accurately locate relevant information from documents, reduce the data entry processes, and focus on higher-value tasks, helping them focus on higher-value tasks.
Growing Bill Review Costs
Traditional medical claims management processes often involve substantial manual effort in reviewing bills, leading to high bill review costs and more personnel handoffs. With modern medical bill processing software, claims managers can take advantage of Ventiv Verify’s technologies to automate the identification of missing and inaccurate data.
Flagging discrepancies and inconsistencies early in the claims review process through the use of a medical bill verification solution reduces the need for extensive manual reviews, resulting in a substantial decrease in bill review fees and overhead. Organizations implementing medical billing software often experience a reduction of up to 17% in bill review expenses alone.
Clunky Handoffs Between Claims Management Software
Integration is a key factor in the success of any healthcare IT solution. Still, many medical billing solutions require multiple manual handoffs, making it easy for adjusters to lose information and make mistakes. Seamless integration with existing claims management systems and workflows is essential for maximizing medical billing. Ventiv Verify’s standardized formats and protocols ensure smooth communication between all software involved in the claims ecosystem.
A well-integrated medical bill verification solution such as Ventiv Verify facilitates data sharing, coordination, and collaboration among stakeholders, leading to a more cohesive and efficient claims management process.
Comprehensive medical billing solutions utilizing features such as document image tagging, OCR document data capture, medical bill indexing scores, prebuilt business rules, and the ability to identify missing and inaccurate data are revolutionizing the landscape of claims management in healthcare. Benefits like auto-adjudication, reduced claims closure time, lowered provider billed charges, improved adjuster efficiency, decreased bill review fees, and seamless claims management integration all contribute to more efficient, cost-effective, and streamlined claims processing.
As the healthcare industry continues to evolve and the intricacy of medical claims increases, implementing advanced medical billing verification software is a necessity for organizations to optimize their operations and provide better outcomes for providers, payers, and claimants.
To learn more about how to get started with medical bill verification software, chat with an expert to see how Ventiv Verify is right for your organization.
