Beat the game of Whac-A-Mole
Those of us who have been in the health care revenue cycle management (RCM) field for some time know there is no such thing as perfection. Unless your business is 100% cash up front, it is impossible to achieve a 100% payment rate. The reality is, by allowing insurance companies to comprise most of your revenue, risk of nonpayment is a given.
Remember the arcade game Whac-A-Mole? The RCM game is a never-ending game where the “mole” is payment issues from specific insurance companies. This week it’s Blue Cross Blue Shield incorrectly denying claims for documentation that’s already been provided. You contact your rep and ask them to reprocess the claims in-bulk that were denied in error. The moment you hang up the phone, the mole is back! Now UnitedHealthcare is denying authorization on items that were previously verified as not requiring it. Back to the phone. This time you’ve got call reference numbers and recordings to prove the authorization denials were in error. They relent, you resubmit, and, pow, there’s the mole again! This relentless cycle of problem identification, problem solving, clean up and repeat is frustrating and demoralizing, leading to home medical equipment (HME) teams experiencing high burnout and turnover in key RCM roles.
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