I don’t think many of us can hear “saving millions of dollars” and not have our ears perk up just a bit. Especially in healthcare, the waste and inefficiencies around claims processes is enough to make any provider want to drop insurance all together. In fact, earlier this year we highlighted how reimbursement woes are plaguing post-acute care providers and part of a bigger picture of tremendous burnout in these vital care settings. But when patients rely on their coverage to get necessary care, it’s a battle worth fighting. But it seems there is a better way to fight…

A recent article from McKnights highlighted how skilled nursing facilities in particular are losing oodles of cash due to breakdowns in the admissions process alone. The reason this data is particularly important to consider is that not all stages of the care delivery lifecycle are the same, and recognizing just how much friction and/or discrepancies in the early interactions between the Referred and Referring personas can cost in administrative head-banging (not the fun kind), it’s a strategic point of intervention.

And you know us: we love a good strategic technology intervention!

Equipping Office Staff with Automation to Reduce Claims Purgatory

We were shocked to read in the McKnight’s article that 80% of denials happen because of the intake process.

Read that again.

When you consider how much is on the shoulders of overburdened office staff, who often lack access to electronic tools that could revolutionize their workflows and transform their ability to communicate with other providers, it’s no surprise to hear that fat fingering insurance plan information or passing along incomplete/inaccurate demographics could result in denied claims and even more time spent chasing down appeals and re-filed claims.

(Have you ever had to deal with the administrative hangover of a single mistyped field of data in the patient record post-claims submission? If not, let us assure you…it’s not awesome.)

The beauty of connected, automated solutions for skilled nursing providers and their staff – as well as those who refer patients to these post-acute specialists – is reducing manual steps and mitigating risk of inaccurate ePHI due to data entry error. The other beauty of improved connectivity between providers (without requiring a pricey or complex technological investment) is that more information is accessible when decisions are being made, such as whether or not to accept a referral for skilled nursing care.

Getting Proactive Data to Skilled Nursing Providers to Drive Referral Management

It’s sadly revolutionary to talk about improving healthcare connectivity via electronic means to proactively allow post-acute providers to better manage their patient census based on incoming data with the referral request. Initiatives like the 360x protocol for referral management, for example, get us pretty jazzed over here. How can you possibly move the needle on outcomes if it’s like getting that alleged “grab bag” only to realize you’re holding a bag of junk? (Not that any patients are junk, of course. But you get the gist.)

Having a robust patient record before a patient even enters into skilled nursing care is absolutely transformational. Yes, it will absolutely mean better communication and continuum of care support from all providers involved. But it also translates to smoother claims processes and approved payments, which is vital to keeping SNFs up and running.

So, while we should absolutely do all the right things for patient-experience reasons, it’s also prudent to remember that healthcare providers are running businesses that rely on minimal dollars left on the table. Where better electronic communication tools become the true prize is in their ability to serve both needs: keeping the lights on for SNFs and keeping the door open for (insured) patients.