- 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.
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 AutomationAutomating 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.