Trillions of dollars in claims get submitted, and several billion dollars get denied. It’s estimated that roughly $5 million in claims per hospital get denied. This results in a lot of lost revenue for your practice. To help you avoid revenue loss, take a look at these ways, you can prevent claim denials.
Understand Your Numbers
Don’t try tackling your high denials right away. Instead, find out your initial denial rate, as well as your dollars rate and claims rate. These will help you find the source of your problems and find ways to improve your practice and raise your revenue. In other words, you can find ways you can stop yourself from losing money.
One of the most important things to ask yourself when looking for a root cause is how early along in the revenue cycle can you address and resolve an issue. The earlier in the cycle you can address a problem the better. It will help your revenue cycle run more efficiently.
More often than you think, upstream problems can mask issues taking place downstream. In other words, issues that appear to take place at the end of the revenue cycle are actually caused closer to the start of the cycle. This can cause confusion with regards to who’s accountable for the issue. If you start looking for problems upstream, you can keep trickling downstream until you find the source of the problem.
Leverage Data and Analytics
Data is of the utmost importance. Find trends in your data and take note of them. Without real-time analytics, there can be significant reporting delays. Delays in reporting can make it more difficult to find errors.
To keep denials from happening, form a team that will put continuous improvements in motion. All departments should be involved in this process, and they should all meet regularly to review the root causes of denials and ways to resolve any problems. There may be initial resistance from departments since they could be skeptical of a potential other program and be hesitant about presenting problems to others, but it will help you long term.
Communicate Effectively and Avoid Placing Blame
Collaboration is always important for solving problems. A common hindrance to effective communication is the fear of consequences when people get blamed for problems that go on. To prevent denials from happening, people have to be able to trust each other and not have to worry about receiving blame. If people think they will get in trouble for disclosing problems, it will be much more difficult to address and resolve issues that cause denials.
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