Streamlining Claims Management: PHIMED's Strategic Response to Increasing Claims Denials

As billing processes continue to become more complex, the challenge of claims denials has intensified, despite technological advancements aimed at improving efficiency. As of 2024, total healthcare spending has reached a staggering $4.8 trillion, almost tripling since the early 2000s.

Findings in State of Claims 2024, a report based on a study by Experian Health, underscores a worrying trend: 77% of healthcare providers report an increase in claims denials, exacerbated by more stringent reimbursement protocols and heightened administrative challenges. Denials not only prolong payment processes, but also place additional strain on resources, adversely affecting patient care and financial stability.

Robotic process automation (RPA) – also referred to as "software robotics" – tackles these issues head on. RPA technology learns and automates into a workflow routine tasks traditionally performed by human hands. Healthcare providers can redirect essential human resources toward patient care and service improvement, thereby enhancing overall operational efficacy.

The strategy behind our RPA platform, PhyGeneSys, is to specifically target the persistent issue of claims denials. The platform enhances billing accuracy and operational efficiency through several advanced features:

• Real-time coding updates and guidelines, ensuring all billing operations adhere to the most current coding standards, significantly reducing denials related to outdated or incorrect coding.
• Meticulously verifying each claim for accuracy and completeness before submission, minimizing the risk of rejections due to errors. This preemptive verification process is critical for maintaining a high clean claim rate.
• Providing tools to review, adjust, and verify claims comprehensively, ensuring that each submission is correct and complete. This reduces the need for subsequent corrections and re-billings, enhancing first-time pass-through rates and optimizing reimbursement.

It also facilitates secure and efficient exchanges between healthcare providers and insurers. This capability is crucial for quickly resolving discrepancies that directly impact the revenue cycle.

We continually integrate new, cutting-edge technologies that enable deeper insights into billing patterns and potential discrepancies, allowing for even more precise and proactive management of claims. This ongoing technological evolution positions PhyGeneSys not just as a tool for managing current RCM challenges, but as a forward-looking solution that anticipates and adapts to future needs in healthcare billing.

Get started with PHIMED's PhyGeneSys?Medical Billing Platform