Automating Claims Status Checks: The Ticket to Accelerated Reimbursement

A healthcare claim status inquiry and response transaction is the communication between a provider and a payer about a healthcare claim. The payer goes through a procedure to check the claim requests for adequate information, validation, justification, and authenticity. At the end of this process, the insurance company may reimburse the money to the healthcare provider in whole or in part. But, this process is filled with time drains.

When a provider contacts a payer to check a claim status, it takes an average of 19 minutes and costs the provider $9.37. By the time a claim reaches a denied status, the provider has lost at least two weeks of valuable time (and money).

Considering that the time between claims submission and payment can be as long as four weeks, these delays are costly. Add to that repeated checks, and denials, and it’s easy to see how this cost can rise.

Automating Claims Status Checks Improves Efficiency

By simply automating claims status checks with Boston WorkStation, healthcare organizations can quickly identify missing claims or information, eliminate timely filing denials, and increase “dollars in the door.” Automating tasks in the revenue cycle allowed the team at Northwestern Medicine to reduce manual data input and oversight, and spend their time on higher-value tasks.

By automating this largely manual process, Northwestern was able to offset the work of 25 FTEs. This did not mean they were let go, but rather allowed to do higher value work, which led to increased employee satisfaction scores.

As Northwestern grew from 1,500 providers to over 3,000, they did not add ONE additional team member to the claims status process. These tasks were automated by Boston WorkStation.

Eliminating the need to manually check claim status frees up 25 minutes per inquiry that your team could be spending on relationship building and communications – activities that require a human voice and skillset. Boston WorkStation goes directly to a payer’s website and retrieves claim status details. Claim status details can then be prioritized and integrated into the EHR, increasing workflow efficiency, and reducing manual steps and duplication of effort. This helps reduce accounts receivable days and improves staff utilization by allowing more timely intervention on any claim that requires human follow-up.

Doing more with less has never been more important in healthcare post-COVID-19. Post-pandemic staffing challenges are higher than ever. Reduced staffing and increased costs make automation a necessity for healthcare. A tremendous amount of time is wasted by revenue cycle management departments checking on claims with no activity. A technology-driven, automated approach to claim status monitoring ensures resources are being expended where they will do the most good, which is working only those claims that have been identified as having issues or exceptions. The result is increased efficiency, faster reimbursement, fewer denials, and less disruption.

The initial claims status check process at Northwestern Medicine revealed a 330% ROI within the first year, which has continued to grow and will continue to grow in perpetuity. In addition to offsetting 24 full-time employees (FTEs) worth of work on an annual basis, the organization was able to double in size during this time. If it had not been for Boston WorkStation automating this process, they would have needed to employ a manager, a team lead, a supervisor, desk space, computers, and associated equipment.

According to a recent PwC CFO Pulse Survey, “One-third of finance leaders say they’re dedicating much more time to inflation than they were a year ago, while 36% strongly agree (and another 46% agree) there will be a recession within six months.”

CFOs are looking toward tech-driven products and services to meet ongoing business demands. By adding Boston WorkStation to front-end processes like claims status checks, Northwestern Medicine is confident that they can not only meet these ongoing demands, but thrive. And they’ve proven this, by exceeding their revenue targets for seven years in a row.

Why Boston WorkStation?

Experience, integrity, and 5-Star support. That’s why customers have turned to Boston Software Systems time and time again over 35 years. Tune into this interview or access the entire series with Northwestern and Matt Hawkins, as they discuss the value of healthcare-specific automation. If you’d like to know more about how automation can add value in the revenue cycle, let’s chat. With most of our solutions deployed in <30 days, savings are right around the corner.

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