Claim denials are a recurring revenue drain for medical practices. Is your hospital constantly battling revenue loss and denied medical claims? Failing to manage denials proactively translates to loss of revenue and workarounds. According to a report by AHA (American Medical Association) 89% of hospitals have seen a rise in denials over the last three years.
Denial management has a strong influence over several key functions such as cost-to-collect and patient access processes. With hospitals operating under razor-thin margins it is important to manage denials proactively and ensure a healthy bottom-line. Where does the path to prevent denials begin? The answer is complex. Most successful hospitals begin by standardizing and making course corrections to existing processes.
A highly efficient denial resolution process doesn’t always mean expensive technology or increase in headcount.
Focus on these Five key areas to reduce denial rates and improve reimbursement.
Prior authorization errors and eligibility verification mistakes account for a majority of claim denials. Nearly 27% of denials are due to registration and eligibility errors. Inefficient patient access processes translate to poor patient experiences as well. In the experience economy unmet patient expectations can have a strong negative impact.
- Implement a insurance eligibility verification checklist and ensure that the process is followed consistently.
- Ask the latest insurance information from the patient.
- Verify secondary and tertiary insurance information as well.
- Standardize the prior authorization process and follow insurer specific PA requirements.
- Keep patients looped in throughout through online communication or a patient portal.
Medical coding related denials are a major pain point for hospitals. Over coding and under coding issues place a huge strain on in-house staff and hamstring revenue integrity efforts. Computer assisted Coding (CaC) can help resolve major medical coding issues. But to achieve long-term, sustainable success current coding processes need to be analyzed for deficiencies. It can lie in an inefficient chart abstraction process or a poor code auditing cycle. Pay attention to the weak links and weed out inefficiencies.
Did your claim not reach the finish line on time? The delay can be costlier than you think. Missing the timely filing limits of insurance companies results in denied claims. A slow claim cycle is the primary reason behind medical claims slipping through the cracks.
Accelerate the claims cycle by eliminating redundant process and moving from paper claims to electronic claims. This small but significant shift expedites the claims cycle and to a large extent prevent crossing timely filing limits.
As reimbursement regulations become more stringent it imperative that medical claims are highly accurate. Errors such as mismatch of patient demographic information, insurer details and other minor oversights result in costly rework and first-level denials. Soft denials are revenue drainers but can be easily addressed. An effective claim scrubbing process and multi-tiered quality checks will significantly bring down claim denial rates. Investing in a claim scrubbing software prevents erroneous claims and subsequent denials.
Payer contracts are periodically revised and it is essential to keep up with contractual obligations. Also, analyzing payer contracts not only helps in reducing claim denials and improves compliance with insurer regulations, it can weed out underpayments. Improve the performance of contracts, optimize reimbursement and reduce denials by performing internal audits or joining hands with a revenue cycle provider to objectively analyze insurer contracts and identify ares of improvement.
Recover lost revenue with the right team by your side
Bring down your denial rate to < 2%