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What We Learned at the 2018 HBMA Revenue Cycle Conference

by Ahmad Jawad, on Oct 23, 2018 9:11:08 AM

It was a great honor to have had the opportunity last week to exhibit at the annual HBMA Revenue Cycle Conference. We are especially grateful to have been given the opportunity to partake in celebrating this outstanding organization's 25-year anniversary.

The conference was not only very educational for both the attendees and exhibitors, but allowed us to hear from medical billing companies on their perspective of the industry,  emerging trends, and challenges they are currently facing.

In the many discussions we had, one consistent theme surfaced many times; within the medical billing industry many believe that if a claim was created perfectly, the associated payment would be received on time and in full. However, what we have found is that the creation and cleanliness of a claim and the associated reimbursement of that claim are two distinct issues and processes.

In short, the billing process is standardized, the payment process is not!

I’ll explain….

In today’s revenue cycle world, it is true that many organizations are finding that their first-pass acceptance rate has increased and in some situations has reached greater than 95%. But it is important to understand that the first-pass acceptance rate ONLY means that your claim has successfully passed the clearinghouse and has been sent to the Payer. This is in part due to the more robust front-end rules engines being utilized and the increasing number of edits used to scrub claims at the clearinghouse.

So, I pose the following question. If the first-pass acceptance rate is extremely high, say 97%, why do denials, underpayments, lost claims, etc. continue to exist?

It is our belief at MiddleGate that creating clean claims is extremely important, but it is also important to understand that clean claims are not directly correlated with full and timely payments. We believe clean claims and payments are two distinct and separate topics. Clean claims are related to the billing process. Payments are related to the behavior of the Payers.  

Again, the billing process is standardized, the payment process is not!





Topics:Revenue Cycle ManagementArtificial IntelligenceThe Claim Game


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MiddleGate delivers technology solutions to improve revenue cycle management. Get the latest updates on our blog where we aim to deliver relevant, cutting edge news and commentary on technology issues within medical billing and RCM. 

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