Are Claims Management Companies Worth It?

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The world of insurance claims can be challenging, intimidating, and downright frustrating at times. Between changing regulations, delayed payments, and unresponsive financial institutions, you may find yourself wishing a fairy godmother would swoop in to magically take care of all your claims and deliver all your payments in light speed. 

Unfortunately, fairy godmothers don’t exist in the insurance claims world. But for many private practitioners, claims management companies are the next best thing. They have the skills and resources to handle your claims processing from start to finish, helping you to secure payments faster while reducing your stress. In short, hiring a claims management company is well worth your investment if you hire a company with a proven track record of success

What does a claims management company do? 

Before plunging into the many benefits claims management companies offer, it’s helpful to understand the role they play for clinics and private practitioners. Claims management companies are typically hired by healthcare organizations to provide one of the following: 

  • Support as needed: They help resolve a particularly challenging claim or a specific issue with one or more health plans. 
  • Full-time handling of all claims processes: In this case, the company would oversee all claims processing from start to finish. 

Claims management companies employ skilled claims specialists who have received extensive training in research, negotiation, and insurance fraud prevention. Most important, their claims managers are armed with an impressive arsenal of techniques to use in collecting payments from unresponsive insurers. 

What are the benefits of hiring a claims management company? 

If you’ve never worked a claims management company, it’s normal to have questions. For instance, you may wonder why you should hire an outside claims manager when you’ve been able to survive without one for years. After all, you have one or two in-house employees who have some experience filing claims. To best understand how a claims management company can transform your practice, take a look at some of the specific benefits of hiring one: 

1. Reduced Stress 

Deadlines, unpaid benefits, and a steady stream of denied claims can have a negative impact your organization’s financial health, which may ultimately lead to anxiety or stress. By hiring a claims management company to handle these challenges and secure payments, you can enjoy a healthier cash flow and minimize claims-related stress. 

2. Faster Claim Processing  

Speedy claims processing matters in the healthcare world. Top claims management companies have fast, sophisticated electronic filing procedures that enable rapid delivery to insurance companies. Electronic filing also helps safeguard against missing information, human error, and illegible handwriting, which can slow down the entire process. In a nutshell, claims that are filed electronically are submitted faster and with greater accuracy. 

3. Fewer Denied Claims  

Physicians and dentists are skilled at diagnosing and treating health problems. But many lack experience when it comes to claims processing. Claims management specialists, on the other hand, know exactly how to avoid claim denials. With an experienced company handling your claims from start to finish, you can expect to see your percentage of denied claims drop. 

4. Improved Financial Health 

“For every 15 denials a practice prevents each month, it not only receives reimbursement sooner but also saves $4,500 per year on costs associated with correcting those claims. In the world of decreasing reimbursement rates, this potential for cost savings and improved cash flow can dramatically improve a practice’s financial health in a relatively short time.” – Richelle Marting, JD, MHSA, CPC, American Academy of Family Physicians (AAFP) 

Electronic claim processing does more than reduce your denied claims. It expedites the entire claim submission process. And faster submission of your claims typically means faster receipt of payments, which gives your cash flow a boost. And when payments do not arrive quickly, a claim management company will swing into action right away to determine what steps need to be taken to expedite payment. 

5. Prevention of Questionable Tactics 

Sometimes insurance companies will purposely delay their payouts. This practice can limit your cash on hand and lead to stress. Claims management specialists can be especially effective in these situations. They know exactly what steps to take when insurance companies knowingly put off payments or refuse to make payments altogether. They are not intimidated by large financial institutions and will file a complaint against them on your behalf.  

6. A Higher Rate of Successful Appeals 

Even the most skilled claims management specialist in the world is not immune to denied claims. Fortunately, claims management specialists have extensive experience handling rejected claims. They can carefully evaluate the reason for the denial and determine whether it would be beneficial to file an appeal on your behalf.  

If the decision is made to file an appeal, your chances of a successful appeal will be greater with an experienced claims manager handling the appeal process. Claims management specialists know all the tips for appealing a denied medical claim. For instance, they will gather and organize all pertinent documentation to include with your appeal paperwork. You can count on a trusted specialist to work tirelessly to build a strong case on your behalf.  

7. Compliance with Laws and Regulations 

As the owner or operator of a medical practice, you are responsible for making sure that your claims filing procedures comply with industry standards. But trying to remain abreast of the latest compliance laws and regulations can be a full-time job. You could end up devoting much of your time to attending compliance seminars, going to meetings, and educating your team. 

With a knowledgeable team of specialists handling your claims, you can count on them to keep track of the latest industry changes. They can even provide guidance on steps you and your team can take to make sure you are adhering to new regulations as you are completing documentation on the front end of treatment. 

8. Negotiation on Your Behalf 

Medical professionals are trained to diagnose and treat healthcare issues. Most are not skilled negotiators. And they are often so busy caring for patients that they have little time to learn how to negotiate with financial institutions. Claims management specialists are skilled communicators who are trained to negotiate on your behalf so you can focus on patient care. 

9. Increased Productivity 

When you hire an experienced company to handle your claims, your in-house employees who used to handle claims activity will now have more time available. This time can be devoted to patient care activities, follow-up calls, marketing initiatives, or any other urgent tasks that require completion. The result is improved productivity and smoother operations. 

10. A Focus on Maximizing Your Payout 

Insurance companies and financial institutions have a vested interest in keeping claims payments as low as possible. Seasoned claims managers never forget this and are always on high alert for attempts to minimize their financial responsibilities. Most importantly, they will stand up to insurance companies and financial institutions in an effort to secure the highest possible payout for your organization.  

A claims management company employee on the phone with a healthcare organization.
When organizations turn claims management companies with their claims process, their team is freed to focus on patient care and other initiatives.

What are the hallmarks of outstanding claims management companies? 

Clearly, there are many reasons to consider reaching out to an industry expert to handle your claims. But it’s important to remember that not all claims management companies are created equal. It’s up to you to choose a company with the experience and resources to manage your claims successfully. As you compare companies, look for those that offer the following: 

  • A proven track record of success: Ideally, the company you choose will have at least a decade of experience successfully managing claims. 
  • Professional memberships: Top claims management companies often belong to organizations such as the ACP and IACP
  • An A+ rating with the Better Business Bureau (BBB): A high grade by the BBB is a testament to the company’s quality and professionalism. 
  • Highly accessible: Leading companies will ensure that you can receive support from a knowledgeable team member 24/7. 
  • Well-staffed to respond to your needs: Make sure the company you choose can provide you with a dedicated and responsive claims manager. 

By using discretion when hiring a claims management company, you can help ensure that you will be satisfied with your results. You can cap off your search by requesting a list of references who have used their services. If possible, ask each referral to summarize the impact on their bottom line and daily operations. 

What steps can you take today to improve your claims processing?  

Hiring a claims management company can positively impact your organization in many ways. From improved claims accuracy to reduced stress, the benefits are significant. But the path to faster claims payments begins with efficient processing on the front end. 

The best way to put your practice on the path to fewer denied claims is to invest Apex EDI medical claims processing software. With five-star technology and an experienced support team driving your claims processing, you can enjoy peace of mind knowing that you have immediate access to top quality resources whenever the need arises. Schedule a demo of Apex EDI to discover how we can help you transform your claims processing. 



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