Small balance claims have historically been overlooked as a significant revenue opportunity within revenue cycle management (RCM) in favor of their higher-dollar counterparts. Unlike high balance claims, which often demand a hands-on, aggressive approach, small balance claims require a scalable strategy. The large volume of small balance claims often exceeds manual processing capacity, requiring healthcare organizations to utilize automation and analytics, strategic work allocation, and a global strategy to maximize efficiency and recovery potential.
How to Leverage Technology, Automation, and Analytics in Small Balance Claims
Maximizing return on investment (ROI) for small balance claims involves leveraging technology to automate repetitive tasks, allowing staff to concentrate their efforts elsewhere. By integrating solutions like API-driven auto claim status updates, automated mass rebills, and automated appeal templates, healthcare organizations can greatly diminish manual intervention.
Additional automation capabilities include:
- Predefined appeal templates that expedite response to common denials.
- Threshold-based auto write-offs, where it’s financially imprudent to assign human resources to work claims below a specific value, and automated touches haven’t yielded results.
- Next-best-action engines, powered by predictive analytics that prioritize claims with the highest recovery potential.
Automation boosts the productivity and effectiveness of RCM team members, freeing staff to handle a larger volume of claims and focus on those that truly require human intervention. Additionally, robust analytics can identify trends and highlight areas of opportunity. The best systems detect trends and recommend actions, such as high-volume denials that can be addressed through bulk appeals, turning small balance trends into high revenue recovery opportunities.
What are Best Practices for Recovering Small Claim Balances?
Ultimately, the small balance challenge is about scale since there are often more claims than a team can handle, especially true in physician billing. Effective small balance claims management begins with work stratification based on the ROI. Claims should be prioritized not simply by age or amount, but by their likelihood of potential for recovery. Examples include:
- Denials within 30 days of the denied date often have higher overturn rates.
- Certain denial types show a stronger ROI when appealed.
- Claim history and payer behaviors can offer clues about recovery potential.
Once stratified, routing the right claim to the right person at the right time becomes a manageable, rules-based exercise. These rules, embedded into standard operating procedures (SOPs), ensure more consistent processes and decision-making. To maintain adherence, real-time auditing and monitoring systems must track whether SOPs are being followed and flag any deviations for course correction.
Another important part of small balance claim adjudication is identifying root causes of these issues and working with the managed care team to address any payer issues directly with the payers. The only thing better than successfully collecting on a small balance claim is preventing them in the first place.
How Can Global Teams Improve Small Balance Claim Success?
Leveraging a global partner for managing small balance claims can significantly enhance operational efficiency and boost ROI through labor arbitrage compared to traditional onshore approaches. A global partner brings specialized expertise with the ability to hire and scale a team tailored for accounts receivable (A/R) low balance experience. This strategic hiring ensures that the team is well-equipped to process claims effectively, utilizing targeted training programs focused on the nuances of small balance management to achieve a higher volume of claims processed while maintaining quality in claim resolution.
In larger-scale projects, additional staffing roles such as a director of denial prevention can provide an additional governance layer, ensuring alignment between operational goals and team output. Identifying and mitigating high-volume denial root causes will reduce the number of claims requiring manual intervention.
Benefits of Maximizing Small Balance Account Recovery
By leveraging automation, effectively prioritizing claims, addressing denial root causes, and investing in skilled staff that includes global resources, healthcare organizations can maximize the efficiency and recovery potential of small balance accounts. Contact us to help implement a strategic approach to small balance claims management to drive impact for your healthcare organization’s revenue cycle and financial performance.
Ryan Chapin
