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Rejection Trend Spotting

Imagine you are driving a Ferrari at top speed through the Italian countryside. What is the last thing you want to see? Speed bumps! That’s what it feels like when you have to deal with claim rejections – it slows down your revenue. In addition, using staff time to fix and resubmit those claims can be a slow process – especially when your office is already pressed for time.

So how do you avoid these “speed bumps?” The first step is to identify which rejections are occurring most often and which are more than just a one-time occurrence. One of the easiest ways to start this analysis is by running a report through your clearinghouse’s software. If your clearinghouse does not offer this option, you will have to manually go through rejection reports and analyze them by hand.

If your clearinghouse does offer an analysis tool, you can probably use it to quickly run a report that details rejections based on total number of claims impacted or by total amount of dollars impacted. Through these tools, you can typically drill down to the specific rejection reason to see if it is occuring at an even rate or if it is trending upward.

If the rejection is occurring at a constant rate, it may be beneficial to review your policy with the payer or simply call the payer for an explanation. It may end up that you need to modify your coding slightly in order to pass edits more consistently and help speed up your revenue cycle. If you find out this is the solution, you can easily educate your physicians and coders to ensure that it does not occur as often.

If the rejection is trending upward, it may warrant special attention to the processes for coding and submitting the claims related to the payer or facility that is receiving these rejections. Did something change recently to cause the upward trend? Your goal should be to resolve these trends before they become major ‘speed bumps’ distracting you from your top speed revenue-run in your Ferrari! Andiamo amici!