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Back to Basics – Denials Management: Reduced claim denials for the win

It’s time for heated rivalries, crazy upsets and hotly contested theories around bracketology. In other words, March Madness is here, signaling the beginning of spring.

Now, if revenue cycle management challenges had a tournament bracket, claims denials might reign supreme. That’s backed by our 2016 revenue cycle analytics survey with Porter Research, where 40 percent of respondents list claim denials as the top revenue cycle challenge, followed closely by patient billing and payments at 37 percent.

And it’s uncontested that stopping denials before they happen is a winning strategy (after all, the best offense is a good defense). However, even the most experienced players sometimes need to revisit this basic element of denials management: prevention.

Today’s analytics technology and automated processes can help organizations avoid denials but also make sense of and appeal the denials that do occur in an efficient and automated fashion.

  • With reports and healthcare data analytics at hand, revenue cycle leaders can pinpoint the underlying causes of denials and how to reduce them. That includes the ability to review monthly, quarterly, and yearly trends, as well as patterns across physicians, team members, or payers. This review will allow organizations to address these patterns to avoid similar denials in the future.
  • Automating processes for patient information verification, eligibility checks and patient estimates can also help. So can pre-populated appeal letters and payer forms and personalized work lists for back-office staff.

With these capabilities in place, the revenue cycle challenges will now become successes and your revenue cycle can see real improvements. Consider the wins respondents to the aforementioned data analytics survey found after implementing a data analytics solution:

  1. 88% of respondents saw improved claims submission
  2. 84% saw reduced rejection rates
  3. 78% saws reduced denials
  4. 76% achieved better cash flow

Post-game analysis? Tracking, monitoring and analyzing why denials happen, combined with automating key claims management processes, is the winning strategy for any busy healthcare organization seeking to achieve greater financial health. Want to learn more about developing a slam-dunk analytics strategy? Click here to download our white paper: Using Business Intelligence to Accelerate the Revenue Cycle.