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Effective Denial Management and How You can Create an Efficient Revenue Cycle

Find out how you can make your denial management system as effective as possible.

Denials aren’t much different from a check engine light in your car. While you could keep driving for miles, it doesn’t make the problem go away and eventually, you’ll need to address the problem.

Hospitals and other health systems need to address their problems too, and one of the recurring problems many of them face is denials. This is why it’s important to have an effective denial management strategy that helps you keep your revenue. Find out how you can make your denial management system as effective as possible.

Getting Familiar with Denials

Denials are common in the industry and as such, they’re just another part of everyday business. But in these modern times, new strategies have to be implemented to keep lost revenue to a minimum.

On average, gross charges that are denied by payers has gone up by as much as 20 percent! This is in conjunction with the fact that around 65 percent of denied claims don’t get worked. It’s problems like these that explain why facilities are losing more money due to lost revenue.

It’s important to know what takes place at your facility. How much money gets lost each quarter because of denied claims? Is the facility likely to continue this trend in the future? If so, there is room to make gains.

Know the State of your Denials

To slow down the process of losing money to denials, you need to determine the top denials that are in your revenue cycle. There are many common issues for denials. Some of the most common include:

  • Missing or false information
  • Timely filing concerns
  • Services not covered
  • Duplicate claims

Most claims denials can be prevented with a strong denial management strategy, and as long as you know what causes the most denial problems, you can take the necessary measures to deal with these problems before they get out of hand.

Build Strategic Best Practices

It’s not a good idea to be reactive when handling denials. The best denial management techniques are proactive, taking measures to prevent problems from happening rather than waiting for them to pop up. Much like the aforementioned engine light, it’s best that it not show up to begin with. To do that, you want to find out what causes your facility problems so that you can take measures to tackle the root of the problem.

The Front End is a Priority

Denials can be caused by many things, so it’s always good to have someone vigilant at the front end to catch any mistakes. Some facilities have clinical documentation specialists working alongside providers to stop problems from popping up that are related to ICD-10. You can also  upgrade your registration and patient scheduling systems to help them catch commonplace reasons for denials.

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This entry was posted on Friday, December 13th, 2019 at 11:36 am. Both comments and pings are currently closed.