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The Impact of Rejected Claims on Your Time and Money

    Maintaining a consistent cash flow is crucial for home health agencies amidst challenges brought by Medicare payment cuts, regulatory changes, and shifts in the payer mix among agencies.

    A fundamental aspect of achieving this goal is ensuring that claims are not rejected. Rejected claims can result in further reimbursement issues, ultimately slowing down your cash flow and affecting your bottom line. Proactively addressing potential problems that could lead to claims rejection will grant you greater control over your cash flow.

    To provide a clearer perspective, let’s break down how rejected claims can impact your time and finances.

    • Less time to file: Different payers give you varying time limits to submit claims. If a claim is rejected, your time to file gets shorter as you work on fixing the issue.
    • Counterproductivity: Your staff ends up spending valuable time fixing and re-submitting claims, dealing with diverse payer requirements, and updating information in your EHR system. This takes away time from your team that could otherwise be dedicated to providing patient care.
    • Delayed reimbursement: The longer a rejected claim remains unresolved, the longer it takes for you to get paid. This delay can create financial challenges for your agency.
    • Lingering issues: Rejected claims often point to setup problems with payers or internal processes. Ignoring these issues can lead to more rejected claims, creating an ongoing cycle of extra work and reduced efficiency.

    Effective Strategies for Minimizing and Avoiding Claims Rejections

    To cut down on claim rejections and keep your cash flow steady, consider these best practices:

    • Fix rejections in 72 hours.
    • Create and share clear processes and responsibilities.
    • Tackle the main reasons for rejections to stop them from coming back.
    • Find out why the payer said no to the claim.
    • Set up payers right and know their billing rules.
    • Partner with your clearinghouse for better checks and balances.
    • Aim for a low rejection rate—ideally under 3 percent.

    Enhancing Coding Practices for Improved Claim Success

    When looking at the primary causes behind claims denials as identified by MACs, many of the issues identified stem from coding errors or can be rectified by improving the coding process, such as the validity of the face-to-face encounter documentation.

    Coders play a crucial role in maintaining accurate and consistent information in all documents for claims. They do more than assign diagnosis codes – they also assist with intake, billing, and review of medical records. This collaboration, when successfully coordinated, helps prevent claim denials and ensures a steady cash flow for your home health business.