Using Analytics to Optimize Insurance Management 

Using Analytics to Optimize Insurance Management 

Insurance management is a critical process for private practices and healthcare providers of all kinds. Of course, the increasing number of available providers and plans has complicated the process and created a demand for better ways to get results and manage claims, denials, and appeals. Thanks to technology, it’s much easier to manage and monitor these areas of your practice. Of course, that’s only if you use that technology appropriately. 

For starters, that means embracing analytics and all that they can do. What are analytics, you ask? These are simply reports and metrics that convey how well a practice’s insurance management methods are working. For example, providers struggling with excessive denials might want to dig into the denials and approvals data to see what’s going wrong. There are several ways that providers can put analytics to use, including optimizing insurance management throughout the practice. 

Approvals and Denials 

Two of the biggest (and most obvious) metrics on your list to monitor will be approvals and denials. Tracking all the insurance preauthorization requests and claims submissions will ensure that everything is done correctly and that there is less of a chance of claims being denied. You can even see details on data about why a claim was denied (more on that next) and start to strategize a way to reduce denials based on that information. 

The saying that the “devil is in the details” couldn’t be truer here—an insurance company is quick to send a denial without much explanation, but a little investigation could help you deduce a bigger issue that requires attention. Some providers realize through monitoring and metrics that there is a gap in their processes or an area that needs attention. 

In this category, you’ll want to monitor things like:

• The number of claims outstanding
• How many preauthorizations are approved/outstanding
• The number of approvals 
• The number of denials 
• The various causes of denial
• Where the process is (pending, processing, awaiting approval, etc.)

You can also monitor appeals in much the same way so that you know which have been approved, denied, need more information, and so forth. This will reduce patient wait times and paperwork, too, leading to increased satisfaction and fewer paperwork errors. 

The Cause for Denial 

One of the biggest things overlooked in an insurance denial is the cause or reason. Common causes include duplicate billing, insufficient documentation, a lack of coverage, etc. However, most providers look at this on a case-by-case basis and never step back to see the bigger picture of what’s really going on. This is where analytics can come into play. 

Using data from the insurance claims that have been submitted or preauthorization requests that have been filed, providers will easily be able to see a quantifiable list of reasons that claims were denied. For example, your practice may have someone less familiar with billing codes who miscodes a service. This could result in a quick denial, but it’s a simple enough fix, too. However, you might not realize that the individual needs additional training and support without the analytics reports. 

Considering that as many as 90% of all insurance denials could have been prevented, this kind of data can be invaluable to practice owners and providers looking to improve their revenues and collection rates. It also helps patients get the care that they need without issues and pinpoints exactly where issues are when they arise. 

The Benefits of Analytics

There are several perks that private practice owners and their staff gain from monitoring relevant analytics, especially when they are related to insurance claims and denials. Namely: 

• Analytics provide quantifiable insight regarding insurance approvals, denials, appeals, etc. 
• This data can help providers create better insurance management practices in the future by addressing obvious pain points or issues. 
• Analytics can be the guidelines to help organizations streamline operations and reduce duplications and inconsistencies. 
• Providers can monitor changing metrics and data over time to see how the organization is changing and evolving. 

This leads to better decision-making and the resources to take a more proactive approach moving forward. For example, a provider might start monitoring the claims activity per insurer to see which ones have the highest claim denial rates. This will then allow the provider to identify why claims are being denied and if it is an issue on their end, to resolve the problem and reduce their denials. 

Knowing the numbers can also help practice owners see what they are missing in terms of revenue, as well as how they may be able to recuperate some of that money through appeals or rebilling. Of course, the hope is to avoid this as much as possible, but it might be required for those who don’t yet have a solid insurance management strategy in place. 

How ClinicMind Can Help

The ClinicMind EHR/RCM platform includes robust reporting and analytics features, including the option to customize reports and data to the needs of each practice. Providers can get detailed insights on revenue cycle management, including insurance billing, claims, denials and processing issues, and more. Plus, all the data can be monitored in real time from the intuitive dashboard and users can even set up custom alerts for certain tasks requiring their attention. 

ClinicMind also assists with coding, billing, and compliance issues, ensuring accurate claims are filed and that there are fewer denials related to these elements. The result is a total practice management solution that optimizes your insurance management and other areas of the business. 

Conclusion 

Insurance management has always been a difficult part of private practice for many providers. There are so many technical details involved and with dozens of insurance companies that all have their guidelines and requirements, it can quickly get overwhelming. Fortunately, with the right practice management tools, you will be able to monitor your insurance processes and optimize everything from start to finish. Not only that, but the rest of the practice will operate more smoothly, too.