Managing healthcare claims can be a challenge for any practice. From claim submission to securing payment, every step requires attention. In athenahealth’s system, claim buckets help by categorizing claims based on their status, making it easier for practices to manage claims efficiently and improve cash flow.
In this blog, we’ll explore what claim buckets are, how they work, and how best to manage them.
What is a Claim Bucket in Athenahealth?
A Claim Bucket in athenahealth is a categorization tool that organizes claims by their status and required actions. Each bucket represents a specific stage in the claims process, helping billing teams see where each claim stands and what needs to be done next. By using claim buckets, practices can quickly identify claims needing attention, reducing errors and improving payment timelines.
Common claim buckets include Billed (claims submitted but awaiting payment), Follow-Up (claims needing further action to ensure payment), and Hold (claims requiring corrections). This structure allows billing staff to prioritize tasks based on claim urgency, helping to streamline the revenue cycle.
Example: A claim in the Follow-Up bucket requires staff to contact the payer for status, while a Billed claim is simply pending response, allowing the team to focus efforts where needed.
The Role of Claim Buckets in Revenue Cycle Management
Claim buckets categorize claims based on their current status and the next necessary action. This setup helps practices stay organized, prioritizing claims that need attention while reducing delays in payment. With claim buckets, billing staff can easily see which claims need action and address them accordingly.
Overview of Claim Buckets in athenahealth
athenahealth includes a variety of claim buckets, each serving a distinct function:
- Billed: Claims submitted to payers and awaiting payment. No further action is required until a response is received.
- Follow-Up: Claims requiring additional actions due to payer delays. Staff need to follow up to ensure progress.
- Hold: Claims with specific errors needing correction, often requiring patient or medical record information.
- MGRHold: Claims needing a billing manager’s review, typically due to complex issues like credentialing or missing provider details.
- Missing: Claims pending charge entry completion. They stay here until charges are entered or the claim is marked as complete.
Each bucket allows billing teams to address claims based on priority and ensure they are handled effectively.
How Claim Buckets Support Efficient Claims Management
Organizing claims into buckets helps practices keep the workflow organized. Each bucket clarifies the action required, letting billing staff focus on high-priority claims. For instance, Follow-Up claims get immediate attention, while Billed claims can wait for payer updates, reducing unnecessary delays and keeping payments on track.
Best Practices for Managing Claim Buckets
To make the most of claim buckets, consider these management practices:
- Review Buckets Regularly: Routine checks ensure that claims don’t remain stagnant. Prioritize high-need buckets like Follow-Up and Hold.
- Focus on Quick Resolutions in Hold: Claims in Hold often need data from patient records. Create a checklist to collect this information quickly.
- Train Staff on Bucket Uses: Ensure billing staff understand each bucket’s purpose and how to handle claims in each, reducing errors and maintaining consistency.
- Use Reports to Track Progress: athenahealth’s reporting tools reveal claim count and duration in each bucket, allowing for pattern identification.
- Address Payment Discrepancies Quickly: In Follow-Up, promptly resolve payment issues to prevent claim delays.
- Streamline Manager Review for MGRHold: Assign a billing manager to regularly review MGRHold claims, preventing backlogs.
Following these practices can help keep claims moving smoothly through the system and reduce unnecessary hold-ups.
Common Challenges with Claim Buckets and Solutions
While claim buckets bring order to claim management, some challenges can arise. Claims in Follow-Up may stall if payers are slow to respond, while Hold claims may need more information from patients or physicians, leading to delays. Clear communication between billing, clinical, and administrative staff can often prevent these issues.
Another common challenge involves recurring issues in MGRHold, often due to credentialing or missing information. Addressing these root causes early can reduce delays in future claims, improving the process overall.
Benefits of Effective Claim Bucket Management
Effectively managing claim buckets can speed up the revenue cycle. With clear categorization, billing staff can focus on claims that need immediate attention, resulting in fewer delays. This streamlined approach helps practices maintain a steady cash flow, enhances financial reporting accuracy, and supports long-term financial health.
Conclusion
Claim buckets in athenahealth provide a structured approach to managing claims, reducing payment delays and simplifying the revenue cycle. By understanding each bucket’s function, implementing regular review practices, and addressing common challenges, your practice can better manage claims and maintain a strong financial position.
With effective claim bucket management, your practice can improve payment timelines, reduce denials, and achieve greater financial stability.
