For many health care providers, keeping up with changes in coding requirements and payer rules is an ongoing challenge that is more than a hassle – it’s a pain in the wallet. Managing rejections often involves a significant amount of additional labor that can strain an organization’s financial performance, especially among provider offices that simply don’t have time and staff needed to resolve denials in a timely manner.

If you go to the root of the problem, you know the best way to avoid denials is to ensure the claims sent the first time to the payers are clean. So how do you do that? You could invest in error analysis and staff training to improve manual corrections. But to really bend the cost curve, you must automate this process.

Take the experience of American Health Network, an Availity client based in Indianapolis, Ind. Its billing staff was overwhelmed by the rework needed to satisfy thousands of claim denials, spending an average of 20 minutes or more per denied claim to research, correct and resubmit each claim. As claim volumes mounted, their manual denial management process became an unsustainable approach.

Claim scrubber to the rescue

The organization decided to try Availity’s advanced claims editing product, commonly known as a claim scrubbing tool, with the goal of reducing back-end denials and the amount of time needed to rework claims. Claim scrubbers automatically scan for errors, coding requirements, and various provider-specific and payer-specific rules and edits that can cause claims to be denied.

An initial pilot with 44 providers yielded results that exceeded expectations. Claims that would have ended up as denials took less than five minutes to work —a time reduction of 75 percent, greatly increasing efficiency and improving time to payment. In the first five months alone, the organization shaved off nearly 750 hours from its billing staff’s time working claims up front vs. having to work them as back-end denials.

“If you fix the claim before it gets to the payer, you have saved much more than 15 minutes,” said Pam Blackford, AHN billing manager. “You have to consider that, if you’re working a back-end denial, you may have to wait six weeks or more to get a response.”

The big win

AHN continued to realize an even greater return on investment after the advanced claim editing tool was introduced across the enterprise. After one year, the organization achieved a 200 percent return on their investment.

AHN managers said more than 4,500 erroneous claims were caught for edits in a single month, saving the organization approximately $1.4 million in corrected claims—an annualized savings of $16.8 million.

Get a sophisticated tool

Significantly reducing your back-end denials and the high staffing costs needed to rework them can be simple, even when payer rules and government mandates are not. A good claim scrubber can be a life-saver, but not all of these tools are created equal. Ask an Availity representative how our advanced claims editing stacks up against competitors, or how to find the right tool for your organization.