Three ways to simplify denial management and achieve cleaner claims
It’s no secret that it’s getting harder for healthcare organizations to get paid for their work. As a trusted provider, you are under increasing pressure to collect more money and cut operational expenses while continuing to provide top-notch care, especially during a public health emergency.
On top of that, you are also still faced with keeping your workforce safe and keeping the public protected while in your facility.
The following are three ways to strengthen your overall denial prevention and management process.
1. Analyze denial management and shift your thought process
While you may consider denials a reality of being in healthcare, it doesn’t always have to be that way. Of course, the recent downturn in the economy is causing patients as well as insurance companies to tighten their wallets. And that directly impacts your A/R days and cash flow.
This increase in financial pressure is elevated throughout healthcare organizations, which are now forced to be creative and find alternative solutions. The good news is that you have more power than you think to prevent denials. It all begins with understanding reimbursement and compliance rules. This also extends to creating rules within your organization to foster excellent care through optimizing internal denial prevention and management programs.
2. Identify types of denials
Identification and analysis allow you to understand a denial’s root causes. You can then put a process or improvement in place so that the same problem doesn’t reoccur. In other words, it comes down to having a proactive approach to denial prevention.
When you can visualize denials by categories, it helps you create rules for your organization that work towards correcting denial reasons and categories. Once hard or soft denials occur, it can be challenging to get them overturned by the payer. Software from ABILITY helps you identify and understand the rule so that you can consistently follow it and prevent future denials.
3. Optimize your clean claims
Accurate, up-to-date information is a critical part of avoiding denials and achieving clean claims. That means that you need to have solid pre-registration, check-in, and intake processes in place. Preferably, the pre-registration process is happening prior to the patient’s visit.
Denial prevention starts with a clean claim. Be sure to validate all the required information prior to data entry so as many errors as possible are avoided from the start. Keep in mind the types of accurate information needed for an insurance company to process your claim correctly the first time. Doing so will help you improve clean claims and get paid more quickly.
Want to learn more about improving your denial management process?
Check out Inovalon’s free, on-demand webinar, Denial Management Made Easy, where RCM expert Kem Tolliver digs deeper into these important topics. By watching, you’ll get an in-depth look at several key terms and definitions and common code sets that are integral to the denial prevention process. You’ll also gain access to additional resources to help you avoid claims denials.
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