8 Tips for Hospitals Dealing With Payment Appeals

Hospitals Dealing

Hospitals face a lot of financial challenges today. While the patient experience continues to improve, high costs, rising insurance premiums, and low reimbursements continue to put pressure on hospitals’ bottom lines. This makes it important for hospitals to establish a strong culture of compliance, as well as an effective process for managing payment appeals. When done successfully, this will help reduce the number of unnecessary denials and speed up payment follow-up time. In this article, we’ll look at some key things you can do now to start improving your hospital’s payment processes and reduce the amount of time it takes for you to get paid later on in the year.

Establish an Effective Appeals Process

When a patient is denied payment or a claim is denied, they are faced with two options: appeal the decision or wait until the appeal process is over. Each of these actions comes with its own particular set of guidelines and deadlines, which you should be aware of and be familiar with. While it’s always best to avoid appeals in the first place, there are times when it’s necessary. If, for example, the patient’s condition is severe, or their insurance company is refusing to pay, it’s important to appeal the decision as quickly as possible. There are a few things you can do to ensure this appeals process is as effective as possible. First, you’ll want to establish an appeals process that is simple, straightforward, and transparent for your patients so that they have all the information they need and feel confident understanding the process. You may also want to create an appeals form that is easy to understand and use so that your staff is aware of the process and is able to guide patients through the process as easily as possible. You’ll also want to make sure that patients are aware of the appeals process at the time of their visit.

Hire a Dedicated Staff for Payment Appeals

If you have the capacity to do so, it’s a good idea to hire a dedicated staff member for handling payment appeals, claims, and all the other processes that are involved with denial management for hospitals. Most hospitals have a few administrative support staff members who can handle these tasks, but fewer have someone with the specific knowledge and expertise needed to get these tasks done effectively. When you have a supervisor who can devote a few hours each day to handling payment appeals, you’ll be able to process a significant number of appeals more quickly. You’ll also see a reduction in the number of unnecessary denials, as the staff member will be able to immediately contact lenders and insurance companies when they receive appeals.

Set Up Automatic Reminders for Payment Follow-Up

When it comes to follow-up, you’ll want to make sure that you establish a process that is as automated as possible. This will help to reduce the amount of time it takes for you to get paid later on in the year, as well as prevent any potential errors from occurring. There are a few different types of payment follow-up that you should make sure you have in place. First, you’ll want to make sure you have automatic follow-ups for your receivables. This will ensure that the hospital’s accountants have a clear idea of how much money is available, as well as a clear sense of when it is expected to arrive. You’ll also want to set up a process for tracking payments that are expected but not yet received, including your third-party lenders and insurance companies. This will help to ensure that payment follow-up doesn’t get delayed and also help to prevent any potential errors.

Hold Regular Meetings with Your Lenders and Insurance Companies

Dedicated administrative staff members are great at getting work done, but they can also be somewhat detached and disconnected from the day-to-day operations of the hospital. To ensure that your payment processes remain effective, you’ll want to incorporate regular meetings with your lenders and insurance companies. This will help to ensure that your payment processes are running smoothly from the front end and that there are no potential issues creeping up from behind. At the same time, including your lenders and insurance companies as part of the appeals process can also help to speed up the amount of time it takes for you to get paid later on in the year.

Communicate With Your Hospital Executive Team

It’s important to remember that, even if your hospital is in compliance with your federal and state health codes, your financial stability is dependent on the payment of third-party bills and insurance claims. If your hospital is having trouble getting paid, it’s important to communicate this to your executive team. This will help to ensure that the right steps are being taken and that the right problem is being identified and addressed. Having a good communication strategy and a process for reporting any payment issues will go a long way in reducing the amount of time it takes to get paid later on in the year.

Conclusion

Healthcare is a challenging business with many complex challenges. Providers need to be compliant with federal and state regulations, while also balancing their bottom line. This can sometimes lead to complications, such as payment denials or payment delays. Hospitals face a lot of financial challenges today. While the patient experience continues to improve, high costs, rising insurance premiums, and low reimbursements continue to put pressure on hospitals’ bottom lines. This makes it important for hospitals to establish a strong culture of compliance, as well as an effective process for managing payment appeals. In this article, we’ll look at some key things you can do now to start improving your hospital’s payment processes and reduce the amount of time it takes to get paid later on in the year.

 

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