Lost revenue. Inaccurate claims. Delayed reimbursements. These are just a few of the challenges associated with healthcare's complex revenue cycle management healthcare systems and processes. Often, they remain unseen or underestimated, silently affecting financial performance and operational efficiency.
In today's competitive healthcare landscape, optimizing your RCM is no longer optional; it's essential. Outdated systems, manual processes, and fragmented workflows can significantly impact RCM performance. Healthcare businesses need robust tools and technology that streamline operations, enhance accuracy, and accelerate reimbursements for healthy RCM numbers.
Enter Mirra's Claims Adjudication software. Fully customizable to the specific needs of the healthcare providers, our innovative software empowers you to take control of your RCM and unlock its full potential. Let's learn more.
Industry Challenges and Barriers in Revenue Cycle Management
Here are some of the most pervasive roadblocks encountered by healthcare organizations:
- Manual workflows and outdated systems: Over-reliance on paper-based processes and antiquated software creates bottlenecks and delays, leading to backlogs, lost claims, and wasted time and resources. A study by the Medical Group Management Association found that manual chart audits alone can cost a practice over $17 per claim.
- Error-prone data entry: Manual data entry is prone to human error, resulting in inaccurate claims and denied reimbursements. The American Medical Association reports that an estimated 20-30% of claims contain errors, costing the healthcare industry billions of dollars annually.
- Lack of real-time visibility: Limited visibility into the healthcare claims management process hinders timely intervention and troubleshooting. This makes it difficult to identify and address issues before they escalate, further impacting revenue collection.
- Fragmented workflows and communication gaps: Siloed systems and communication silos between departments create delays and inaccuracies. The American College of Healthcare Executives reports that as many as 42% of healthcare leaders cite interoperability issues as a major barrier to RCM performance.
- Uncoordinated claim denials and appeals: Lack of a systematic approach in managing claim denials and appeals results in lost revenue and extended reimbursement cycles. A study by the Healthcare Financial Management Association found that the average time to resolve a denied claim is 48 days, costing an average of $250 per claim.
Impact on Revenue and Operational Efficiency:
These challenges have a significant cascading effect on healthcare organizations, leading to the following:
- Reduced revenue: Lost claims, denials, and delays in reimbursement directly impact cash flow and profitability.
- Increased administrative costs: Manual processes and error correction require additional manpower and resources, straining budgets.
- Decreased operational efficiency: Slow workflows and delays hinder productivity and service delivery.
- Patient dissatisfaction: Long wait times and billing errors can lead to patient frustration and damage your reputation.
Mirra's Claims Adjudication Solution: The Answer to Your RCM Challenges
Mirra's Claims Adjudication Software directly answers these pervasive industry challenges, serving as an advanced, purpose-built platform to provide healthcare organizations with the capabilities they require to make their revenue cycle management healthcare processes better.
A Tailored Solution
Mirra's solution is a comprehensive software platform designed to address the specific pain points faced by healthcare organizations.
Key Functionalities and Features:
- Automatic Claims Processing - Automation expedites the entire healthcare claims management lifecycle while eliminating manual errors for faster, accurate submissions.
- Real-Time Error Correction - Sophisticated rules identify issues for rapid correction before costly denials can occur.
- Unified Member Profiles - Consolidated member data enables streamlined workflows, boosts accuracy, and eliminates toggling between systems.
- Custom Analytics & Reporting - Actionable insights into RCM performance help inform and drive smarter decisions.
- Seamless EHR Integration - Integrates perfectly with existing EHR systems for a smooth transition.
- Built to Scale - Our cloud-based platform easily scales to match the needs of growing provider groups.
- Bank-Level Security - Robust measures ensure the protection of sensitive patient data and ensure compliance.
Mirra's Claims Adjudication Solution offers advanced features that increase performance:
- Prior Authorization Management: Automated routing and decision-making tools enable prior authorization, ensuring timely approvals and quicker patient care coordination.
- Appeals and Grievances Management: Easily manage the appeals and grievances process with built-in workflows and tools, ensuring timely resolution and improved patient satisfaction.
- Claims Denials Management: Identify and address claim denials efficiently with automated workflows and tools, reducing administrative costs and accelerating reimbursements.
By implementing Mirra's Claims Adjudication Solution, healthcare organizations can overcome all RCM challenges and experience a range of benefits.
Benefits of Using Mirra's Claims Adjudication Solution
Mirra revolutionizes RCM , unlocking tangible benefits through advanced automation. Our solution delivers:
A. Improved Claims Processing Efficiency and Accuracy:
A recent study found that automation can reduce claim processing time significantly
Mirra automates claims processing end-to-end, accelerating the workflow while eliminating errors and driving faster reimbursements.
B. Streamlined Adjudication Processes for Faster Payments:
In practice, Faster reimbursements translate to improved cash flow, allowing for reinvestment in critical areas like patient care and technology.
Our robust automation engine expedites adjudication and payments for healthier cash flow and financial performance.
C. Reduced Administrative Costs and Minimized Errors:
Mirra's Claims Adjudication Solution isn't just about efficiency and cost savings; it's also about gaining a competitive business edge.
Automating manual tasks slashes administrative costs and prevents costly denial-causing errors.
D. Customized Solution and Easy Integration Capabilities:
According to a recent industry report by KLAS Research, 90% of healthcare organizations surveyed reported achieving a smooth and efficient integration with their chosen RCM software when they partnered with a vendor that offered customization and dedicated support.
We customize our solution to each client's unique needs and systems for smooth integration.
E. Real-time Error Detection and Correction Functionalities:
This proactive approach to error detection has been shown to reduce claim denials by up to 10%, according to a study by the Healthcare Financial Management Association. This translates to significant financial savings and improved cash flow for your organization.
Real-time error correction tackles issues proactively, preventing denials and protecting your bottom line.
The Bottom Line
Let technology do the heavy lifting. Mirra automates routine tasks, freeing up your valuable staff to focus on more strategic initiatives and patient care.
By investing in Mirra's Claims Adjudication Solution, healthcare organizations are making a strategic choice for their long-term success. Improved financial performance, enhanced operational efficiency, and a competitive edge are just a few of the benefits you can expect to experience.
Ready to unlock the full potential of your RCM? Contact Mirra today to learn more about how our solution can help you achieve your financial and operational goals.