Who can deny the challenge of denial management?

By Lindsay Stratman

You’ve delivered the care. Your team has diligently documented the encounter and coded the claim. They’ve ensured it reflects everything they know should be included for that specific payer and that patient, and they’ve incorporated all of the relevant information from the front office and existing records.

Then the claim is denied.

What happened?

A closer look at denial management

Preventing denials is an organization-wide effort. It starts in the front office and extends across the clinical and coding teams, with multiple cruxes in the back-office revenue cycle world. Providers need the right solutions but they also need a comprehensive framework that encompasses all the interconnected parts of denial prevention.

3 takeaways from our denial and appeal management webinar

#1) Even when denied claims are adjusted and reimbursed, payment typically reaches the provider 30 to 100 days later than it would have if the claim hadn’t been denied.

  • Efficiently working denials can improve this—and identifying root causes of denials can help prevent it altogether.

#2) Working the right claims, in the right order of importance.

  • Workable denials are claims that have adjudicated by the payer and have the potential to be paid once corrections are made and/or additional info is included—and some are more valuable than others.
  • Now-workable denials are claims that have been adjudicated—but cannot be adjusted. Reasons can include fee schedule adjustments, duplicate charges, and secondary payer acknowledging the claim was already paid.

#3) Denial management is proactive—and retrospective.

  • Proactive reduction of the occurrence of denials—especially those that are more easily preventable—is foundational to slashing your overall denial rate.
    • Reducing your denial rate reduces your operating expenses—specifically, the cost of reworking claims.
    • Workable denials still drive up days in AR – slashing your denial rate accelerates reimbursement.
  • Retrospective appeal of denied claims ensures more complete reimbursement—and accelerating the appeals process ensures more complete reimbursement more quickly.
    • It also enables revenue recovery—reimbursement that would otherwise have been lost.
    • Done right, it can enhance staff productivity – staff will be focused on the denials that are recoverable and that have the greatest financial impact on your organization.

Denial management extends across RCM, end-to-end

When you take a closer look at denial management – and the most common root causes of denials – it’s clear the effort to drive down denials runs from the front-office and clinical side of the house to back-office and follow-up teams. Dealing with denials requires smart automation, just like all AR management efforts. Identifying the right claims to pay special attention to on the front end and the key processes in the front office can all significantly contribute to reducing denials. Software that automates the most time-consuming aspects of working denials ensures those claims that are denied are efficiently translated to what they truly are: revenue that providers are owed, and should realize.

Source