Around 6 to 8 percent of revenue losses are incurred primarily due to payment denials for many healthcare organizations. Since these types of losses directly affect the healthcare organization’s revenue resources, a loss of such an extent cannot be overlooked by the healthcare providers. Streamlining the denial management is the chief key to enhancing your revenue and is vital to patient retention.
Five Significant Tips to Improve Denial Management in Healthcare
If you are facing a constant struggle in managing your denials, our tips would surely assist you in effectively enhancing your revenue cycle:
1. Comprehend the Reason for Claims Denial
The foremost crucial step is comprehending the reason for denying your patient’s claims. By doing so, you get a clear picture of how to effectively streamline the process avoiding risks of claims denial but smoothly enhancing the revenue. The entire process of how it works, your patient may not know as well as how the claims management and denial systems functions. In such instances, it is highly appreciated to educate your patients and help them understand the tedious process and why an insurance claim gets denied. You can build an excellent patient-provider relationship with your patient when you assist them throughout the claims process.
By doing so, you create a long-lasting relationship with your patient, and in turn, you can generate better revenue while your organization thrives and remains successful. Hence trying to understand the possible reasons behind your patient’s claims denial and clearly explaining them to them paves the way for a smooth function.
2. Efficiently streamline the Process of Denial Management in Medical Billing
In case you have been manually attempting to fix the claims, which are a short-term solution, it is high time you consider efficient streamlining of this process. The prime task of an efficient procedure is to assist you in minimizing such issues from recurring and offer you a long-term solution. Your revenue and credibility are put at risk if you lose track of the denied claims and if the records are incomplete. Monitor the claims by using a well-organized system that helps you track and efficiently manage the denied claims. You can lift the pressure and relieve your staff from the tedious workload.
With the advanced tools available in the market, the process gets simplified, helping your team monitor the denials keenly and handle them efficiently. It is best to remember a general picture while fixing future issues.
3. A Weekly Process of Claims is Highly Advisable
Efficient handling of claims and timely resubmission of any appeals is crucial for the success of the denial management process in healthcare. It is best to process a denial within a week when it is received from an insurance company. It is believed that around 65% of denied claims were not resubmitted.
It is essential to have a dedicated team to skillfully operate the claims management. By employing such a team, you can easily avoid these piling issues. The staff must be well-trained to handle these claims at ease and ensure to resubmit them promptly if there are any appeals. It is crucial to create a robust workflow to address the process of claims denial.
4. Claims Denial log implementation & common trends in claims denial to be identified
Maintaining crucial data by implementing a claims denial log is a wise option. It is much better if you could keep an electronic version, as it offers access to relevant information across the organization. The vital data about service date, the demanded amount, medical codes of denied claims, and discrete claim numbers can quickly be recorded and accessed. Previous filing errors can be evaluated, and there is room for improvement in better coding and billing systems when a proper claims denial log is maintained.
The Healthcare industry is drastically transforming; hence the claims denial sector trends consistently get upgraded. Once the different claim denial trends are identified, it becomes easy to establish an effective procedure for claims denial management. You get a processing edge over your competitors when you upgrade your knowledge about these trends. Not only that, you can save many costs as well.
5. Outsource to Denial Management Services and announce incentive programs
It is wise to consider an expert outsourcing service for your denial management. By doing so, you minimize the costs, reduce the time and effort but enjoy efficient claims processing. While their dedicated team works on relieving you from the complications involved in the insurance system, you can focus more on the core competency as tasks that could drain you get delegated to an efficient outsourcing company.
Despite the higher software costs, try announcing interesting incentive programs that motivate the staff to reduce the claim denials. If you favor fruitful results, it is wise to create healthy competition by offering time-offs or attractive staff bonuses. When such tactics are applied, you can definitely see a notable reduction in claims. Keep your staff updated with the recent trends so they can contribute better to your claims filing process. Ensure to reward the team when they do exemplary work contributing to your favorable results.
Steering clear of Denial Management Challenges
Some of the common denial management challenges in healthcare are as listed below. When these challenges are addressed promptly and appropriately, you can witness a seamless claims denial management process.
1. Poorly trained staff 2. Lack of Automation 3. Weak Financial Resources 4. Absence of applicable technology 5. Moving to value-based care