3 Steps to Becoming More Proactive in Managing and Preventing Claims Denials

Claims Denials

Claims denials are a costly burden on healthcare organizations and significantly affect the bottom line if not managed well. Revenue Cycle leaders often bear the responsibility for managing denials within the organization, many of which are the result of upstream processes. With the ever-changing billing requirements, it’s easy to become distracted by the daily business of working claims denials and never take actionable steps toward preventing them. Here are a few steps you can take to become more proactive:

  1. Bucket denials by type and category. This makes it easier to take a focused approach toward root cause analysis.  For each denial category, look for opportunities to introduce system edits, standardize workflows, change workflows, and provide education to end users with the goal of reducing and preventing denials. To ensure long-term sustainability, review accountability structures and establish a baseline for target metrics. This helps leaders throughout the organization understand their role in denial prevention and management.
  2. Review denial workqueues and workflows. Insurance follow-up workflows and the structure of workqueues can greatly impact the results of claims appeals and ultimately denial reporting. By analyzing end-user workflows, account prioritization, workqueue build, and appeals processes, healthcare providers can decrease A/R days and account write-offs.
  3. Review denial reporting tools.Reports need to be easily accessible and consumable for leaders. Evaluate current reports and usage to assess improvement opportunities. Data points need to be reviewed, mapped, and grouped for optimal reporting and trending.

Next Steps:

At Parallon Technology Solutions (PTS), we understand the importance of having sound denial analysis tools and prevention strategies in place. During our assessments, we engage a cross-functional team of clinical and revenue cycle experts to analyze denial categories, review workflow processes, identify root causes, and assess management practices.  Our goal is to help you develop a plan to move the needle from claims denials management to prevention. For more details on the low-cost, short-term analysis PTS provides, you can download our solution overview here.

Our team is experienced and we have been successfully providing services to hospital systems for over 15 years. PTS has the highest quality experts and our network consists solely of ex-Epic or highly tenured industry professionals. To start a conversation or schedule a meeting, please email us at info@parallontechnology.com or call us at 855.276.9112.

Going to UGM 2018?

While you are making your schedule for the UGM 2018 conference, please make sure to join us on the evening of August 27th at the Old Fashioned to experience the downtown Madison nightlife at one of Wisconsin’s favorite venues. We would love the opportunity to learn more about you, your organization, and current Epic needs.

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