Healthcare providers should track claims first-pass resolution rate to determine how to reduce accounts receivable (AR) days. The topic was introduced in the article, “Reducing Accounts Receivable (AR) Days with Revenue Cycle Management Technology (How to ensure claims first pass resolution rate of 90% or more Part 1).” Though this article and the aforementioned can stand alone, it may prove beneficial for providers to read both guides, Part 1 and Part 2, of how to achieve a first-pass resolution rate of 90% or more.
Achieving medical claims first pass resolution rate of 90% or more requires not only Revenue Cycle Management technology but also support services. These services should facilitate medical billing efforts, providing full service resources for healthcare providers. Though providers can conduct electronic claim submissions directly to the payer, the stakes are too high to leave success to chance. Thus, to attain the highest possible first-pass rate, providers should partner with a revenue cycle management company, like Health Recon Connect.
Revenue Cycle Management (RCM) companies have the software tools and human resources to help healthcare providers reduce accounts receivable (AR) days. RCM businesses can leverage the provider’s electronic health records (EHR) system to create an electronic claim. RCM technology would then utilize software edits to make that claim “clean,” free of format and coding errors, by “scrubbing” the data to meet HIPAA EDI X12Nstandards. Overall, an effective RCM system drives efficient and standardized integration of provider, patient, payer and medical coding information to increase the first-pass resolution rate.
Though RCM companies welcome the weight of enabling revenue growth, healthcare providers still have some work to do on their end, the front-end. Providers have to officially establish their business presence and those of their physicians, and other healthcare professionals, before seeing patients. This effort entails establishing unique identifiers, EINs and NPIs, and credentialing and contracting with payers, among other necessary processes. If providers are not aware of these front-end issues and/or do not manage them well, it hinders the ability to ensure a first-pass resolution rate of 90% or more, reduce AR days and improve revenue growth.
The following terminology, and aspects of electronic claim submission, present the information providers need to know on some level. Healthcare professionals can leverage this knowledge, listed from A to X12, to mobilize claims first-pass resolution rate (FPRR) of 90% or more.
Deriise Dowell is an Atlanta based healthcare IT copywriter and advocate of efficient billing services, having served, empathetically, as an Enrollment Specialist and Technical Analyst for 11 years.
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