It’s time to transform insurance claims processing.

As thousands of mental health therapists and administrators will tell you, processing health insurance claims is rarely, if ever, a seamless and cost-free exercise.

Here’s the reality: Nationally, health care practices lose billions of dollars a year to insurance processing inefficiency.[1] Claims adjudication and denials reach nearly $26 billion.[1] 18% of denied claims can be tracked to administrative or clerical mistakes such as coding errors or missing information.[2] The pain goes deeper than that.

The finger of blame can be pointed in two primary directions: at maddeningly complex insurance reimbursement protocol and at antiquated EHR and practice management technology. 

Complexity

The insurance reimbursement journey itself is long and arduous, and full of twists, turns, and potholes that can easily delay or derail a claim. 

The purposely lengthy payment journey only serves the purposes of insurance companies while taking revenue and time away from therapists. Worse, it’s chasing many providers away from insurance-pay models altogether. That hurts patient access. 

Technology

Another sad reality is that much of today’s practice management technology slows down claims processing and insurance payments. You’d think (or hope) that the opposite would be true. Practice management systems are not built to manage a complete claim lifecycle. Third-party (such as middleware or clearing houses) integration is clunky. Interoperability between data silos act like puzzle parts that never seem to fit cleanly. 

Given technology’s limitations, manual intervention is inevitable. Therapists have no choice but to dedicate staff time and practice expenses to walk claims through the process, step by step, beginning to end. 

Rethinking the process

You know how the current insurance claim submission process goes. It starts at the completion of a patient visit. You generate an invoice for that visit and your EHR sends it out to an insurance claim clearing house. Often, the clearing house sends that invoice to a third-party administrator such as a revenue cycle management (RCM) company for further processing and, eventually, forwarding to the appropriate insurance carrier. 

Then, you wait. Cross your fingers that errors are not discovered along the way and the invoice doesn’t come back to you unpaid—in which case, you essentially start the process all over. 

This is no way to run a business. 

It’s amazing to think that, even after some two decades of technological development, EHR systems still lack the infrastructure to improve practice management, much less address the complexities of insurance processing. That’s another sad reality. 

But it’s all about to change.  At MediSprout, we’re designing automated insurance claims processing that doesn’t stop at form generation. Therapists have told us that they need a soup-to-nuts solution that tames the entire process. 

Cutting out the middleman

Automated and seamless claims submission built into the MediSprout platform removes time-consuming and costly “middleman” steps that bog down your practice. 

After each patient visit, MediSprout automation generates a claim — codes and all, accurately and automatically filled into the proper fields — and then submits that claim directly to the patient’s insurance carrier. Our built-in Smart Clearinghouse and thoughtful technology design make it happen. No-third party portal to navigate, no docs to export, and no duplicate login required. Just less friction in the process, fewer hops around the planet, and more time back in your day. 

There’s no guesswork about the status of your claim, either. Real-time Claim Tracking plus Status Updates (also built-in features) pull back the curtain on the whereabouts of your claim. From submission to acceptance to paid, the status is there to see at any point, along with alerts that help you get ahead of slowed or delayed claims.  

This is technology the way it should be — designed to be more than just seamless, but to also help you thrive.

MediSprout is taking important steps toward fixing the long-running and costly problem of insurance claim submission for mental health practices. We’d love for you to join us.   

Ben Putland is the chief operating officer at MediSprout.

Sources: 

  1. Premier, Claims Adjudication Costs Providers $25.7 Billion
  2. Counterforce, Insurance Denial Statistics