It is not uncommon for staff to minimize the significance of claims processing. For example, staff frequently assumes the third party payer has processed the claim appropriately. With this mentality you are sure to take a hit on reimbursement. Insurance companies make numerous errors that if unnoticed can cost you a significant amount in reimbursement. Examine the explanation of benefits and compare it to the agreed upon contracted amount to be sure the claim is processed correctly.
Errors commonly occur with multiple surgical procedures or extensive ancillary services.
Your staff must be skilled in monitoring reimbursement and ensuring claims have been processed appropriately. In terms of analyzing financial performance, prepare and examine monthly reports that compare your major payers performance over time. If you have typically adjusted 25 percent for a payer and you notice the contract adjustments climbing to 30 percent, it's time to take a closer look at the payer's performance. Or, if one payer has typically accounted for 10 percent of your amount over 90 days and suddenly it jumps to 20 percent , this is an indicator that something is wrong. It will require further investigative action on your part.