How Provider Interaction Reduces Claims Reimbursement Waste

Unreliable provider communication leaves patients vulnerable to expensive and potentially harmful medical errors, delays the medical billing process, and distorts quality of care.

Reducing claims reimbursement waste demands a closer look at the inner workings of the medical billing environment and how to improve provider interactions. A lack of communication may be a leading cause of claims reimbursement waste and many other weak facets of hospital revenue cycle management.

Financial waste often results in a lower care quality across a hospital or medical practice. But a redirection of communication priorities may help eliminate millions of dollars of annual waste from a hospital’s budget.

One type of costly waste involves how resources are used – including their underuse, overuse, and misuse.

This kind of waste may result in preventable complications, according to an October study published by American Journal of Managed Care.

The effective balancing of financial incentives requires measures, researchers claimed.

“Program implementers can use measures to gauge the impact of accountable care reforms, which may be particularly important for high-cost conditions and treatments.”

A hospital typically wastes $1.7 million annually because of its staff’s weak coordination and communication, confirmed research from the Ponemon Institute and Imprivata.

This means every twelve months, the healthcare system reportedly wastes a total of $11 billion.

Surveyed healthcare providers claimed communication efforts were merely not fast-paced enough to remain effective. A lot of their communication, they said, consisted of waiting for someone to get back to them or explaining information again that apparently got lost in the dialogue shuffle.

“Technology should eliminate, not create, barriers to delivering effective patient care, which is why clinical and IT staffs need to work together to implement solutions that enable fast, efficient communication to improve provider productivity for better focus on patient care,” stated Sean Kelly, MD, Imprivata’s Chief Medical Officer.

“Efficient communication and collaboration amongst providers is critical to the coordination and delivery of patient care, especially within an ACO where quality is impacted in part by the promptness of care delivery,” explained Thomas Kloos, MD, Executive Director for the Atlantic Management Service Organization.

Why cutting out the middleman may prove effective

When communication across healthcare providers becomes blurred or distorted, the quality of care may suffer. Medical errors and malpractice issues may consequently become more prevalent.

“Patients and providers rely on information being timely, accurate, and accessible. When communication is unreliable, then providers and patients dependent on being fully-informed are left vulnerable to medical errors that can lead to serious harm,” said a report from CRICO Strategies.

Nearly 40 percent of communication between providers includes erroneous clinical findings, such as those that are unable to be read, or are either incorrect or untimely.

According to the report, one helpful strategy is to cut out the middleman when possible so communication does not bounce around from person to person unless necessary.

Perhaps it is merely about removing the if onlys from future provider dialogue.

“[If] only the note in the record had been more prominent; if only the patient’s wife hadn’t left the room; if only the nurse had not been afraid to ‘bother’ the physician in the middle of the night.”

“A nurse or physician says or documents only what is critical before moving on to the next task; a colleague reads or listens with less than full attention amidst the chaos of a busy office or inpatient unit; a physician sees a patient for a scheduled visit without the expected test results necessary to conduct a thorough evaluation.”

Making sure staff members are expediently informed of claims transmission errors is also imperative, said Janice Crocker, MSA, RHIA, CCS, CHP, in Journal of AHIMA.

“Loading and maintaining accurate payer and patient information in the system will alleviate many revenue cycle problems. Building in Medicare, Medicaid, and certain fee-for-service contract fee schedules into the accounts receivable module will help monitor accuracy of payments.”

Nonetheless, things like improved care coordination allegedly slash medical errors by nearly a third.

And making sure the patient’s true voice, honest intentions, and candid concerns are heard is also of utmost importance.

“Revenue cycle is impacted positively when organizations successfully integrate safety, quality, and service,” stated James Merlino, MD, Press Ganey’s President and Chief Medical Officer, to RevCycleIntelligence.com.

“About 440,000 people in the United States die annually from preventable hospital errors. It is the third leading cause of death in the United States, which should shock us.”

“You can be the best surgeon in the world, practicing at the best hospital in the world. But if you commit a safety error because you were careless and a patient has a complication and dies, your being the best is irrelevant.”
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Photo courtesy of: RevCycle Intelligence

Originally Published On: RevCycle Intelligence

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