Medforce Blog

How to Establish a Healthcare Denial Management Process that Boosts ROI

July 05, 2017

Category: General

It may be hard to imagine, but denials don’t have to be built-in bottlenecks.

Just like a doctor diagnoses illness, healthcare organizations must learn to diagnose denials.

Most employees in healthcare are entrenched in the traditional way that we’ve always worked denials. This approach is antiquated, time-consuming, error-prone, and very costly. Yet nothing is being done differently. It’s time to break out of the mold.

Becker’s Hospital CFO report says that CFOs spend most of their time thinking about how to revamp the healthcare denial management process. They are likely losing sleep at night over it. As much as 5 percent of your provider revenue can be lost and some organizations experience denial rates as high as 20 percent. Fixing that problem can do wonders for your ROI.

We’re all aware of the biggest culprits: coding errors, manual mistakes, simple misspelled names.

But how do you fix the problems? High performing companies have figured it out. They diagnose their denials, using software and techniques to get at the root causes of why denials are happening, refining their processes over time, and getting to a point where they can identify potential problems before they even occur.

Here are some key strategies that successful companies have used.

  • Understand the “why”. First, you must understand why your claims were denied. Segment and group together like-denials to get a grasp on the bigger picture of where your process is failing.
  • Educate. Many healthcare organizations working with patients and insurance companies have begun to provide patient education about claim denial. Not all patients are going to be experts when it comes to insurance and many don’t realize the effects of not keeping you updated on minor changes that have big impact on paperwork requirements. They’re just frustrated because a denial could mean out-of-pocket expense. Educating your patients means that they can help you solve the problem. At the same time, their patient satisfaction skyrockets because they feel engaged and informed.
  • Organization is key. Your process must be organized and methodical. Your office can’t lose claims or let them pile up. Have a successful denial strategy and a continuous workflow that keeps that pipeline from becoming stagnant. This is why many organizations are using technologies and software tools that help.
  • Be timely. Successful offices correct claim denials in a week or less. We work with our clients to get insight into denials in less than 24 hours.This also helps meet insurance company denial appeal time limits.
  • Review. Once you have a process, your entire staff should revisit what’s working and what isn’t regarding your unpaid claims. This is the most effective exercise you can do to improve efficiency. What are your most common denials? Pre-existing conditions? PIP applications? Coordination of benefits? Take the time to examine the details.

How We Can Help

Our Accounts Recievable Management app gives healthcare the insight and tools you need to fully work a claim. Our claim analytics tools are invaluable tools for efficiently working claims and denials; we will examine your denials and downsize your DSOs.

Our feature-rich reporting helps you quickly analyze the reasons for your denials. We make it very easy to spot the areas of your revenue cycle that need to be refined. Quickly analyze remittances and create redeterminations with supporting documentation.

Stop spending hours and hours of manual labor on healthcare denial management. Do things differently. You’ll soon see that more effective management of your claim denials can increase your organization's revenue and collections rate while improving patient satisfaction. And that means fewer denials to worry about in the future...so your CFO can finally sleep at night!

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