🇺🇸United States

Rework and Resubmissions from Inaccurate or Incomplete Verification Data

3 verified sources

Definition

Errors in recording eligibility, benefits, or authorization numbers force back‑end staff to rework claims, correct data, and resubmit, raising the cost per claim and extending the revenue cycle. Professional guidance to chiropractors explicitly stresses thorough verification forms and procedures to avoid this rework.

Key Findings

  • Financial Impact: If 10–15% of claims require rework at 10–15 minutes each of billing staff time at $20/hour, a clinic submitting 400 claims/month can easily incur $260–$600/month in avoidable rework labor, excluding the cash‑flow cost of delayed payments.
  • Frequency: Daily
  • Root Cause: Offices lack standardized verification forms and procedures, so staff miss key data elements (e.g., policy ID, pre‑auth/referral numbers, visit limits); incomplete or incorrect information then triggers denials or payer requests for additional information, requiring corrected claims.[1][6][7] Poor documentation of verification outcomes in the chart or billing system means information must be re‑gathered later.[1][6]

Why This Matters

This pain point represents a significant opportunity for B2B solutions targeting Chiropractors.

Affected Stakeholders

Billing specialist, Front desk staff, Office manager, Chiropractor/Owner

Deep Analysis (Premium)

Financial Impact

$260–$600/month • $260–$600/month avoidable costs • $260–$600/month avoidable expenses

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Current Workarounds

Assistant collects insurance info verbally and handwrites on intake form; transcribes into EMR; no real-time validation; relies on billing team to catch errors • Billing Specialist manually researches attorney client matter requirements; calls attorney office and insurance carrier separately; paper notes filed in 'special handling' file; email chains documenting back-and-forth • CMS portal checks noted in EHR or Excel

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Methodology & Sources

Data collected via OSINT from regulatory filings, industry audits, and verified case studies.

Evidence Sources:

Related Business Risks

Unpaid or Written‑Off Visits from Skipped/Bad Eligibility & Authorization Checks

For a 2‑DC clinic seeing 80 insured visits/week at $70 allowed per visit, a conservative 5–10% of claims lost or written off from eligibility/authorization issues equates to ~$1,100–$2,200 per week, or ~$4,800–$9,600 per month.

Regulatory and Payer Compliance Exposure from Improper Medicare & Pre‑Auth Handling

While specific dollar amounts vary by audit, even a small post‑payment review clawing back 6–12 months of improperly billed chiropractic services can easily reach tens of thousands of dollars in recouped payments plus administrative and legal costs.

Excessive Labor Cost from Manual Insurance Verification and Pre‑Auth Chasing

A single FTE spending 3 hours per day on manual calls and follow‑ups at $20/hour costs ~$1,200 per month; replacing even half of that effort with automation yields ~$600+/month in avoidable labor cost, not including opportunity cost of staff not performing revenue‑generating tasks.

Payment Delays from Eligibility- and Authorization‑Related Claim Denials

For a practice averaging $60,000/month in insurance receivables, if 30% of denials stem from coverage/eligibility issues and remain unresolved for an extra 30–60 days, this can tie up $6,000–$12,000+ in working capital at any given time, effectively a hidden financing cost.

Lost Provider and Staff Capacity from Phone‑Based Verification Bottlenecks

If front‑desk staff lose even 1 hour/day to payer calls that could be automated, that is ~21 hours/month; at $20/hour this is ~$420/month in wasted capacity, plus the revenue lost from patients who could have been scheduled or checked in during that time.

Risk of Perceived Upcoding or Medically Unnecessary Care When Verification Is Weak

Potential losses include payer recoupments of months of claims and termination from insurance panels, which can remove a large share of a clinic’s insured revenue; a clinic deriving 60% of revenue from one payer could lose tens of thousands per year if deselected.

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