Denials are a constant headache for healthcare organizations and their financial executives. With the denial rate increasing over the past few years, it’s time to step back and reevaluate processes. This blog will review three tips for success from the Change Healthcare 2022 revenue cycle denials index.
An average of 12% of claims were denied upon initial submission in 2022. That is an increase of 3% since 2016. Registration/eligibility has been the highest cause of denials (22%) for many years but has been showing slow improvements. These denials are preventable, but 55% of the time are not recoverable. With such a high percentage of denials that are preventable, organizations need to focus on training, processes, and technology to succeed.
To make a change, you must find the underlining causes of why your claims are being denied. Training your front desk staff to understand the causes and identify them will help decrease preventable denial rates. Change Healthcare recommends that healthcare providers “Implement proper training, including automated feedback loops providing personalized as well as aggregated insights, to help staff identify trends quickly and prevent unnecessary denials” (Change Healthcare, 2022). The tight labor market is impacting the ability to find qualified staff, so having training and education programs are essential as staff turn-over occurs.
Assist teams in improving processes and workflows by establishing a feedback loop. Automate workflows and improve productivity by optimizing resources and utilizing technology to supplement and increase productivity. Focus on strategies for denial prevention on the front end and mid-cycle. Once your team finds a process that works for them, stick with it, and analyze it regularly to be as efficient as possible.
To be successful with medical billing, you need to invest in modern technology. Revenue Cycle Management or Practice Management systems need to be updated on a regular basis to ensure compliance with regulatory changes. Ensure your organization has automated analytics that flag potential denials so you can address them before a claim is billed. Identify denials that are non-recoverable early on, so your team doesn’t waste time working on them. Rely on automation to increase productivity and reduce the strain on your team. When you use technology the correct way, it can transform your processes and streamline your workflows.
If your organization is having trouble minimizing denials, we can help! At Outsource Receivables Inc., we focus on efficiency and have state-of-the-art technology. We work to improve your cash flows and increase your revenue. Try out our ROI calculator to see what we can do for your medical billing.