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Health Systems + Hospitals, Physician + Specialty Practices

Top 4 Actions to Bring Down Your Denial Rate

There’s no denying managing your denial rate is tough. Which explains why denials are one of the greatest hurdles healthcare billing teams face — in fact, 76% of providers say denials are their biggest RCM challenge.

With payer guidelines constantly changing and the number of Americans with health insurance growing, knowing where denials are happening and why isn’t a luxury — it’s a necessity.

Here are four things providers can do to keep denial rates low, revenue high, and their staff productive.

1. Prevent denials before they happen

Physician practice denial rates generally range from 5–10%. Considering denial reworks cost an average of $25 per claim, you can see how costs add up. Luckily, the majority of denials are preventable.

Most practices begin their billing process with eligibility verification, either during patient scheduling or at patient arrival. That’s when many errors occur due to the complexity of payer contracts and other factors. Even getting a claim in the right format and sending it along is time-consuming.

The good news is there are cutting-edge (and easy-to-use) technology solutions that enable staff to identify denials before they happen—for example, by letting team members verify eligibility with a single click and by making sure every claim is in the right format, populated with the right information.

2. Simplify and prioritize workflows

After submitting a claim, a practice can receive a denial at various stages and for many reasons, such as lack of medical necessity or failure to obtain a pre-certification. Denials coming from many different directions create bottlenecks and place strain on staff.

The right analytics tool can streamline denial workflows, only surfacing those that have a chance of getting appealed so your team doesn’t waste time on unworkable denials. You can also prioritize claims by value and probability of appeal, and easily assign tasks to team members.

3. Automate appeals

Once a claim is denied, an appeal has to be sent back to the payer—and every payer has different fields and formats to fill out. Preparing and sending appeals takes up valuable time that your staff could spend on higher-value tasks. Denial management technology can help you prepare appeal packages with prepopulated, payer-specific letters, and either print them for snail mail or send them electronically.

4. Improve training and processes

Your processes are only as good as your data. When you know exactly what your denial rates are, down to the specific team member, you can see where things need to change upstream. A successful analytics solution will give you insights to refine staff training or amend processes to make sure everyone is working at their most productive.

The wrap up

The right technology makes it easy and intuitive for you and your team to manage your denial rate. Look for the following features to make sure you’ve got the tech that will give you the best return:

  • Scrubs and analyzes your 835 data to identify ways to avoid denials
  • Excludes non-workable denials automatically, so you can focus on denials with a higher likelihood of successful appeal
  • Prioritizes denials by payer, dollar value, reason for denial, and more
  • Appeals up to 100 denials at a time right from your HIS or PM system
  • Automates the appeals process by pre-populating payer-specific forms
  • Reporting features that help identify root causes of a denial
  • Easy, seamless integration with your claim management system

To learn more about how to defeat denials with data, check out our whitepaper.

Find out how much more revenue you could realize — and staff time you could save — with the right analytics tool.

Calculate Now

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