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Denial Management And How To Prevent Denied Claims


Take a look at these hacks that can make denial management less burdensome on you and your staff.

$262 billion were denied from a total of around $3 trillion worth of claims, which roughly translates to almost $5 million in denials for every hospital. About 65% of denied claims are not resubmitted, and 58% of all denials come from commercial payors. Health organizations can get overwhelmed from appealing denials due to all of the time and money it takes, and it can be tough to create a prevention program that isn’t too burdensome on their staff.

But it doesn’t have to be this overwhelming. There are tips and tricks to denial management that can make it much more manageable for your team. Take a look at these hacks that can make denial management less burdensome on you and your staff.

Know Your Numbers

Before dealing with high denials, make sure that you know your denial rate, claims rate, and dollar rate. Knowing these will let you uncover the root cause problems, learn how you can improve, and define the size of every opportunity. In short, you’ll learn where you can recoup maximum money and where you can rid yourself of problematic trends.

If you appeal almost all of your claims from a specific payor and you’re consistently winning appeals, this suggests you have a high chance to coordinate with your payor for process improvement. If you’re losing appeals, it’s likely there’s a process error upstream where you could make process improvements that rid yourself of the issue.

Also, be sure that you don’t hunt big-dollar denials exclusively. Denial management isn’t done solely on larger denials. There may be small, recurring problems that you could resolve.

Fish Upstream

Something you want to ask yourself is how early in the revenue cycle process can a problem be addressed and resolved. The earlier it can be addressed, the more efficient your revenue cycle, as well as denials prevention program, will be. Analyze your revenue cycle process; often, an upstream problem could camouflage a downstream activity, which can create confusion revolving around accountability.

Leverage Data And Analytics

Data is vital in denial management, so look at your data and try to find trends. Use analytics to your advantage so you can reveal patterns on data. When you use analytics, denial management is less taxing because the data is more predictable.  If you do not have real-time analytics capabilities, it’s possible for reporting delays to happen. Analytics is a vital resource, so make good use of it to reveal trends that could be losing revenue for you.

Team Up With All Departments

Denial management is made much easier when working with groups. Build a team that will implement constant improvements. Get all of the departments involved and meet regularly to talk about root cause concerns and how to have them properly addressed. Expect initial resistance from the departments. They could be suspicious of a different program and be hesitant to air problems in front of other people.

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This entry was posted on Friday, August 2nd, 2019 at 3:10 pm. Both comments and pings are currently closed.