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Improving documentation for a more effective clinical claim management process

One tardy claims document means a delay in payment—and a series of late documents could mean a financial crisis, or worse. But for hospice and home care providers who constantly need the signatures of off-site physicians and specialists, implementing an effective claim management process is easier said than done.

Failure is not an option, but the task is a formidable one. Getting all those claims documents aligned, signed, and sent out on time is a job in and of itself. The good news is that new technology can help you leverage your EHR system to help automate the claim management process. The result? No more chasing down documents, and many fewer missed payments.

In other words, embracing the opportunities of digital documentation doesn’t mean just improving processes and workflows. It’s also a golden opportunity to streamline claims processing and payment in ways that can better support your long-term financial health. Here’s what you should know.

Why documentation is critical to claims process management and billing

Let’s start at the start: Signed documentation is almost always required for a home or hospice provider to receive payment on a claim. Often, a back-signature is required, too. The document must then be placed back in the patient record before you can bill for the claim.

This is all clear enough in theory, but it’s a little trickier to manage the process. How can you know whether you have outstanding documents at any given time? And, especially if you’re short-staffed, how can you ensure that you’re getting those documents out the door as quickly as possible, and in as few steps as possible?

Plus, billing and clinical teams are often siloed apart from each other, without clear or consistent communication. Clinical staff may be able to see all outstanding documents, but the financial team may not have access to the same info until they’re trying to bill. That could lead to misfiled claims, which could in turn mean a delay or even a missed payment.

Finding the right tools for an effective claim management process

A better-organized process for claim documents—and improved visibility of that data—can be a game-changer. In a situation where overlooked, unpaid claims can have a big impact on your bottom line, the ability to see every bottleneck at a glance means no claim is left behind.

It also means that no claim is filed before it’s time. With MatrixCare EHR solutions, for instance, users can customize their claims hold settings so that the right people can see exactly what’s outstanding at any given time. That gives your team a much greater ability to organize and manage claims, and to submit them only when they’re ready—not too early, or not too late.

The system also lets administrators track documents at the level of detail required to see what needs to be resent, resubmitted, or double-checked at any given time, and to more easily adjust to unexpected changes.

Integrating the 3 key methods for claims documentation

Systems like MatrixCare are designed to not only manage and track these documents, but to automatically create them, send them out the door, and track them back for signature, too. It’s a robust, largely automatic system, compatible with:

  1. Manual documents. This simply means printing out paper copies and either mailing or faxing them to the physician.
  2. Physician portals. These systems send an email to physicians with a hyperlink to documents that need to be reviewed and signed. With MatrixCare, that email will include a link that will direct them to the documents they need to address. Once in the system, they can easily view them, mark them as signed, or reject them. And if it’s a rejection, the system sends an alert.
  3. Electronic fax (eFax). An embedded fax module allows for the sending of documents directly out of the system. At MatrixCare, our eFax system is set up to bridge manual documentation with another electronic option. This lets physicians keep their preferred way of doing things without having to learn another EHR system while helping organizations get more efficiency and accuracy from that manual process.

With the MatrixCare system, each fax includes a customizable cover sheet, and each page is barcoded for the sake of instant organization and documentation. The right people will be able to instantly identify who the physician is, what type of document it is, which patient it’s in regards to, and everything else that matters.

The MatrixCare system also includes analytics to help you improve your claims processing system even further. By determining the average time it takes to file a claim, for instance, you can better understand your own internal processes and how to improve them for greater efficiency and expediency.

The bottom line? The ability to turn around claims documents and get them out the door as quickly as possible isn’t just a great way to do business, but quite possibly the edge you need to stay competitive in a difficult marketplace. And with MatrixCare, the tools to do just that are already at your fingertips.

Ready to take your claims management process to the next level? Let’s connect!


Susan Young
Susan Young

Susan is a Senior Financial Product Specialist with MatrixCare Home and Hospice. Susan has worked in the Home and Hospice industry for over twenty years in various roles from software implementation and training, process improvement and sales demonstrations. Susan enjoys working in the Home and Hospice arena and sharing her knowledge of the MatrixCare core values and software features with prospective clients. Susan works from her home office in Atlanta and enjoys traveling, especially with her husband Larry.


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