Effectively Managing Claims Submissions for EMS
For both provider agencies and billing services, implementing a simple KPI to monitor claims submission activities involves four important measurements:
1. Are you meeting daily goals for dollars billed per day?
To protect the health and profitability of your organization, you need to make sure the revenue being billed supports your cash flow requirements. To view this information, your billing software should come equipped with a Claims Processed report. With a report like this, you are able to track the total number of claims processed and the dollar amount billed. It’s important to review both claims processed and dollar amount billed at the individual biller level, not just a summary—otherwise, a high-performing staffer or an abundance of high-dollar claims can skew the results. In an environment like EMS billing, this level of scrutiny is important to make sure you recover every dollar possible for every claim, as quickly as possible.
2. Are claims at risk for missing filing deadlines?
In almost any EMS billing operation, claims can still get stuck in the system or otherwise not get worked. Before long, such claims are at risk for missing filing deadlines. That, in turn, means lost revenue. Therefore, it’s essential to have solid processes in place to identify at-risk claims while there’s still time to work them.
Within the processes you’ve established, make sure you are able to list any claims that have not been touched for a specified timeframe—doing this will serve as your last line of defense to be sure that no claim misses a filing deadline. When monitoring metrics for this KPI, your goal for the number of claims that actually miss filing deadlines should be zero. But “catching” a high number of claims that are at risk for missing filing deadlines isn’t good either, as it indicates potentially serious problems in your operation. Be on the lookout especially for increases in the number of claims that get caught in this way.
3. Of the claims being submitted, how many are rejected or denied?
Staying on top of denied claims is one important way to ensure that you’ll be drawing in the maximum amount of revenue possible. Accordingly, for any billing operation, “No claim left behind” is a good motto to have. In order to identify those claims that are rejected or denied, it is imperative that you have processes in place to:
- Easily spot rejected or denied claims after submission
- Routinely review the reason(s) for each claim’s denial
- Systematically track trends for overall claims denials
When evaluating your billing software, look to see whether these metrics are offered as a built-in report, and monitor the results frequently.
4. Are there claims that have not been paid within the specified timeframe?
It is important to stay aware of all claims that haven’t been paid within the specified timeframe. Make sure you can quickly see all outstanding claims in one easy-to-find location. Using a reporting tool within your billing software can help you not only locate late payments, but also easily assign someone to follow up. Another indicator of performance is your billing operation’s ability to follow up on unpaid claims within a specified timeframe after they have been identified as outstanding. To give you up-to-the-minute notifications of when a payer has not paid, ask if your billing software allows you to configure alerts so that you stay attuned to outstanding claims.
Using the questions and answers above, you can be sure you have the information you need to identify trends, improve processes and be certain that no billable claim gets left behind.
ESO is here to help.
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