Denials are a bottom-line damaging problem for hospitals, clinics, and practices everywhere. In most cases, denials are also recoverable or preventable. To truly slow the revenue leak healthcare businesses need to make changes to their revenue cycle strategy (RCM).
Be Preventive with Analytics!
To reduce denials and stay on track, identify what is causing your denials. Luckily, we’re in the age of analytics and practice data is just a click away. Figure out and track what root issues (be that – registration errors, insufficient or incorrect documentation, false coding, or billing errors) is the right first step in closing the faucet on revenue leak. From there, whichever base issue is having the biggest impact can be strategically corrected.
Get Effective at the Registration Stage!
According to Healthcare It News, “About 30 percent to 40 percent of denials are the result of registration and pre-service related challenges”. Having staff perform timely, standardized, and proven eligibility checks throughout the patient journey prevents qualified patients from slipping through the cracks.
Plan in Advance with Pre-Authorization!
Streamline the pre-authorization process by dedicating a group of employees or looking to a Revenue Cycle Management service to provide guidance on meeting all points of integration. The back-and-forth information passage between the care provider and payer needs to be prompt and precise. A smart way to hasten pre-authorization is changing it from a completely manual process to an automated step in a workflow. Solutions such Net Health’s RCM services systemize pre-authorization processes to satisfy payers and maximize workflow efficiency.
The Denials Challenge
Few hospitals would admit to not having a denials management program, yet one in five claims for services already rendered is denied or delayed.