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DECREASE MY DENIALS

Improving Denials Means More Abundant Cash Flow

Insurance claim denials are labor intensive and reduce your staff’s focus on accounts receivables or other priorities. But how can you decrease your denials and increase recoveries? And, how do you use the information learned from these denials to avoid future issues?

Even with the most effective software, all hospitals experience some level of claim denials. Common causes are:

  • Coordination of benefits
  • Missing demographic or name misspellings
  • No or limited insurance coverage
  • Expired insurance eligibility
  • Pre-existing conditions
  • Duplicate submissions
  • Accident details
  • Expired submission timeframe

While its easy to lay blame on payers, often it’s wise to reflect on internal processes to ensure quality. Many times the answer lies in human error. There are times when a patient’s handwriting on intake paperwork or doctor’s notes are unclear and lead to mistakes. Sometimes it can be missing demographic information, a wrong diagnosis code or a missing authorization number. Denials can be prevented by increasing filing accuracy. It’s important to slow down, review your claims before hitting the submit button, verify demographics or ask physicians for clarification on notes.

Only 35% of provider’s appeal denied claims. Developing a denial management program can increase cash collection rates while improving patient financial satisfaction.

First, understand why the claims were denied. Keep your process organized with workflow software to maximize resolution quickly. Track your progress and identify the most common denials and trends so you can make upstream improvements to reduce future denials. A lower denial rate means more abundant cash flow.

If you’d like to learn more about denial follow-up workflow software that provides you Next-in-Queue™ capabilities, dashboards and reporting or discuss how our highly-trained specialists can provide denial management services, contact us, we can help.

Ask How We Can Help.

Reduce your denials by:

  • Organizing your process with workflow software to maximize resolution quickly
  • Implementing a system to precisely track every denial’s root cause
  • Integrating an upstream change process to keep denials from reoccurring
  • Tracking and monitoring appeals and recoveries
  • Generating appeal letters
  • Standardizing the denial process within multiple systems and facilities
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