Revenue Cycle Managers at healthcare facilities around the country shudder at the mere thought of denied claims, even though such claims are a consistent feature in their lives. A Denial Management strategy that emphasizes tracking leaks and plugging them in time can be very beneficial in preventing revenue losses that are doubtlessly giving you sleepless nights.
Escalated claims denial rates across payors have been spelling danger for healthcare units for quite some time now. Healthcare reforms that lean heavily towards reporting, value-based payments, frequent revisions of coding regulations, and cutting down payment rates have done nothing but exacerbate the situation for the healthcare industry further in recent times. With the denial rate being as high as 5% for Medicare and up to 2% for private players, hospitals and practices are exploring a promising ‘Rejection Prevention’ model to replace their former denial management system that stood on the philosophy that denials need to be reactively handled as and when they come in. The newer approach in this field has helped administrators realize two things:
- It is vital to glean lessons from the historical data that is available in health systems concerning claims for which rejection was preventable. Such information can be used to create a meaningful action plan to ensure unnecessary denials are prevented.
- Not all denials are avoidable and, therefore, it is vital to have a separate, highly focused plan of action for managing those claims that get denied despite all the precautionary measures taken as part of the point mentioned above.
A certain degree of meticulousness is needed to scrub each claim till it reaches a state of flawlessness before submission. The following three procedural overhauls can help you reduce the frequency of claims rejection in a big way:
- Spruce Up Your Front-End RCM processes. The front office at any hospital or practice is the first contact point for patients. Gathering all the initial payment-related information happens at this stage. Since one of the most common reasons behind the denial of claims is lack of sufficient or accurate information, polishing the front-end processes like pre-registration, registration and appointment management can help seal the cracks that cause denials. Some steps that can be taken in this direction are providing adequate training to front-end staff, creating job aids that include details of what data needs to be collected at what step, and conducting regular audits to pinpoint areas that need more attention.
- Consider Automation – Automating large chunks of your claims management cycle can free up your staff so that they can concentrate on sanitizing the information that is going into the claims. A technology-based system can also help in reducing the burden of keeping up with payor regulations that often vary from one payor to another as well as coding requirements that are also predisposed to frequent changes. Besides, high-end data analytics can prove to be very beneficial when it comes to auditing your claims and denial management processes.
- Do Not Procrastinate Once A Claim Is Rejected. Correcting and resubmitting denied claims can be a painful process. However, it is crucial to complete this activity well in time to avoid payments that are written off for good. Such missed payments can add up to an enormous number by the end of the year, leading to a deep fiscal crisis for your organization. A simple workflow that tracks the flow of all claims including those that have been denied can help keep such claims on the radar, therefore, ensuring that they do not go unattended.
If all of the above suggestions sound like too much work, there is another option that you can consider which is outsourcing your claims management work to a reputable third-party entity. Mirra Health Care is one such entity that can help you enormously by putting some of its best, most qualified claims management professionals on the job to cut down your claims denial rate and get you the maximum amount of reimbursement possible.