Maintaining consistent revenue is crucial to any healthcare organization, and ensuring clean claims go out the door is one way to decrease denials. A clean claim is one that was accurately processed and reimbursed the first time it was submitted to the payer. This is something that every healthcare organization can do to ensure timely reimbursement.
It can be costly for a practice when denied claims are not processed, or are written off as untimely filing. This is because the typical practice denial process looks something like this:
- When a denial is received, the biller might post the information into the organization’s system
- Someone is assigned to work on the denial
- This person reviews the reason for denial and then follows up to correct the denial, or post it as unrecoverable
- The amount might be written off as contractual allowance, or there might not be tracking of the reason for denial
- Of the denials that can be fixed, the billing clerk makes the necessary changes and resubmits the claim with updated information
While this process can work for some, it doesn’t always recover total reimbursement for the services rendered, nor does it uncover the root cause. And that time spent fixing a claim can be costly. That’s why it’s important to learn the cause of the denial and to fix the problem ahead of submission. An advanced medical billing service, like Quanum Revenue Cycle Management (RCM), can give an organization the ability to fully track denials. They will receive a report on the number of claims denied, listed by denial reason and insurance plan. With this information in hand, the healthcare organization is able to review the prior month’s denials and look for trends. When trends are identified, processes can be changed, codes updated, eligibility checks automated, etc. This information should be reviewed on a weekly basis. The goal is to identify trends and to eliminate the reason for denials, not just to correct one denial at a time.
“It takes five times longer to go out and fix individual denials than it does finding and taking care of the problem up front,” says Mark Anderson, CEO of AC Group and healthcare IT futurist. “You want your clean-claim rate to be 95%.”
To learn more about how to reduce denials, watch the webinar, “Improve your bottom line by reducing claim denials,” featuring Mark Anderson. Mark will break down the complexities of denial management and provide useful steps to reduce the risk of denials.
Consider reading another post about reducing denials.