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Don’t Take “No” for an Answer: Three Steps to Improving Denial Management

DonaldTrumpFired_MemeTo people outside the healthcare industry, the term “denial management” probably sounds pretty odd. The concept of tracking how many times you’re told “no” is foreign to someone dating or even job searching; after all, it’s expected to get a few negative responses mixed in with the positive.

In healthcare, however, a strong denial management program is critical – and as far as claims are concerned; even one “no” should be unacceptable. While one denial may not equate to much lost revenue, 50 will. To that end, taking steps to optimize denial management can greatly improve your practice’s financial health:

Stop denials before they happen. A practice struggling with front office tasks such as eligibility verification will most likely have more denials. Correctly verifying benefits at pre-service, or even at time of service if necessary, eliminates a great deal of back-end work. In addition, it’s important to code claims correctly before they are sent to the payer, as this can also reduce denials on the back-end.

Get the most out of technology. On the front end, use technology to facilitate eligibility checks, verify patient information and generate patient estimates. On the back end, rely on pre-populated appeal letters and payer forms, and streamline denial workflow with personalized work lists.

Track, monitor and analyze. Review denials on a monthly, quarterly and yearly basis to identify trends. What are the underlying causes? Do denials originate from one physician or team member? Are they primarily coming from the same payer? This data can help you determine why denials are happening and how you can reduce them.

Building good denial management processes can ensure your practice doesn’t lose revenue while keeping staff as efficient and productive as possible. Learn more about how you can improve your practice’s denial management process by downloading the Get Your Game On: Managing Denials in a Complex Reimbursement Environment webinar presented by Elizabeth Woodcock.