Rapid changes in regulatory rules is causing significant revenue leakage to hospitals and clinics. This has forced healthcare providers to deepen their focus on a robust claims denial management system. These changes are mostly in the form of new contractual requirements by insurance companies with providers, mounting pressure on patients to share payment responsibility, and above all a dated claims denial management system. In light of these challenges, here’s a look at some of the best practices that denial management companies must follow to stop hospitals from bleeding revenue:
Implementing registration best practices- Considering the fact that the chief goal of denial management companies is to reduce the number of claim rejections, it is essential that they adopt registration best practices to begin with. Patients should be offered pre-registration before their appointment to verify their insurance prior to their office visit. It is crucial to obtain patients’ photo ID and address verification to get the correct demographics which are important for the payment. Patients should be convinced to sign an acknowledgement of the fact that if an insurer denied to cover, patients should be responsible for making the payment.
Adopt a structured denial management process– It starts with proper following up on rejected claims by denial management companies. It becomes a daunting task to keep track of every single claim when they pile up. Misplaced or lost files makes the task to follow-up even more complicated for denial management companies. In order to address this challenge, companies are leveraging denial management technologies to avoid any instance of claims misplacement. This simplifies and smoothens old claims management while keeping a track of the new claims. These technologies aid denial management companies secure instant information that is key to determine the feasibility of a claim appeal.
Identification of denial trends– Interpreting and recording denial trends is key to properly segregate and quantify claim denials. To do so, denial management companies are advised to collaborate with payers and healthcare givers. Application of data analytics is the go-to way to identify these trends and spot the root cause as well as the evolving reasons for claims denials.
Accelerated claims denial processing– It is essential that denial management companies incorporate an accelerated workflow model to handle denied claims. Hospitals rely on their efficiency to address a denied claim within a shorter span of time. Denial management companies are expected to leverage a robust process to track and register claims as soon as they reach their system. This is extremely crucial as hospitals are bound by a deadline to file appeals for denied claims. Failing to meet this deadline results in the expiry of the appeal validity.
The onus lies on denial management companies to implement a robust system that can be followed as a standard practice by hospitals to drive their revenue cycle management process. This is crucial as alternative payment systems are exerting a downward thrust to claim reimbursement rates.