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Error Processing Workflow Best Practices

  • Client Success Manager, XIFIN

A critical goal of providers is to submit clean claims promptly when billing for laboratory services, diagnostic x-rays, or durable medical equipment. Otherwise, they risk minimizing their organization’s revenue and overall financial success.

Crucial to clean claims is understanding the importance of managing “Error Processing” queues. At XIFIN, we support our clients through regular complimentary webinars, where team members with expertise across the various revenue cycle management disciplines share best practices. In our most recent webinar, team members discussed XIFIN RPM’s error processing workflow as well as prioritized actions, improved automation, and how to identify actionable items using error processing (EP) search.

An error has the potential to interrupt the state of flow. Unpriceable or unbillable errors can stop an accession from being billed on a statement. This is where error processing comes in. XIFIN designed error processing in a way that involves retrieving information with the least amount of manual intervention so that a claim can be billed and subsequently paid.

Prioritized Actions

With XIFIN RPM, an error or exception that enters an error processing (EP) queue follows a prioritized action. If the error remains after the first action, it enters the next step until it is solved or placed on hold. The process includes:

  1. Auto Match Compare — A background process automatically fixes missing or invalid demographic data on the accession.
  2. Manual Match Compare — A background process attempts to identify matches for all accession/payor combinations.
  3. Manual – Used only when research or manual intervention is required. 4. Outside Agency Pre-Correspondence – Integrates automated demographic and insurance discovery.
  4. Outside Agency Pre-Correspondence – Integrates automated demographic and insurance discovery.
  5. Correspondence – Seeks assistance from either the requesting client or the responsible party associated with the accession.
  6. Outside Agency Post-Correspondence – Integrates automated demographic and insurance discovery.
  7. Appeal Letter – Generates an appeal letter to the payor following an adverse decision.
  8. Appeal Letter – Requires supervisor interaction.

As soon as an error reaches the final action of Hold, a supervisor needs to intervene. As a supervisor reviews errors, they should consider whether the resolution could have been automated. At XIFIN, our Client Success Managers provide guidance to help our clients properly and efficiently use automation.

Client Success Managers also encourage clients to reevaluate their error processing workflows at least annually with focused attention on the top-twenty errors. 

Additionally, business intelligence capabilities can simplify revenue cycle management data to uncover actionable insights while also allowing detailed data exploration. Understanding complex data surrounding error processing and using that information for better decision-making and optimized workflows has never been more straightforward.

Recommendations for Success

  • Identify top denial codes using the EP Dashboard and define automated actions.
  • Implement the practice of assigning employees to work specific errors by utilizing automation available in XIFIN RPM.
  • Pay attention to frequency- or unit- related denials. If the payor only allows a set number of units, use consolidation rules to control the number of units and avoid unnecessary denials.
  • Reevaluate errors after implementing changes to prioritized actions.

Want to know more about error processing workflow? Request a meeting.

Did you know that the metrics you review every month could be misleading? Discover the top financial trends and obstacles in the industry, and how laboratories can better manage each of those challenges in this webinar. Watch Now

Published by XIFIN
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