Boosting Staff Efficiency: Four Tactics to Outsmart Denials

 



Denials within the realm of healthcare persist as a perpetual and escalating issue. By 2022, denials constituted over 11% of claims, posing a significant threat if left unaddressed, as they can severely compromise an institution’s financial well-being and prospects.

The combination of outdated technology and manual processes exacerbates the burden on staff, time, and finances when dealing with denied claims. Notably, unresolved denials can lead to an average loss of up to 5% of net patient revenue.

Moreover, denials remain a dynamic challenge due to evolving payer regulations, patient shifts between medical plans, and other external variables beyond an organization’s control.

To proactively tackle and manage denials, organizations should implement four essential steps.

  1. Understand the prevalent reasons behind denials

Denials can arise from various sources, often rooted in errors or oversights such as registration inaccuracies, issues with medical necessity, delayed submissions, lack of pre-authorizations, duplications, requested additional information from payers, or coding discrepancies.

Here’s what to do:

Dedicate time and resources to thoroughly scrutinize your denial data. Once you’ve gained insight into the prevalent denial types specific to your organization, prioritize areas that necessitate adjustments. Evaluate workflows with the most substantial impact and introduce technology solutions in critical domains.

  1. Enhance processes to proactively minimize rejections

Prevention remains the most effective strategy against denials. The revenue cycle’s procedures for confirming eligibility, securing prior authorizations, and meticulously tracking claims significantly influence downstream denial rates.

Here’s what you can do:

Scrutinize your workflows concerning eligibility verification, prior authorizations, and claim status monitoring. Delve into the policies of your primary payers concerning medical necessity. Proactively embed these criteria into your Electronic Health Record (EHR) system to address and adhere to these specifics.


https://www.allzonems.com/boosting-staff-efficiency-four-tactics-to-outsmart-denials/

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