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No Denials Tool in Place Means Opportunity for Improvement

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A recent study released by HIMSS Analytics found that 31% of providers do not have a formal denials management tool in place and use a manual process.

Healthcare IT News responded with this article on how this creates opportunities for providers and vendors alike, as 60 percent of respondents that do not utilize a denials management tool plan to purchase one within the year. “That means the industry is essentially on the cusp of all providers needing a modern and effective way to handle denied claims,” says the article.

OS President Lori Zindl is no stranger to the need for fast and effective denials management. In 2009 Zindl and her team spearheaded the development of efficientC, OS inc.'s proprietary claims management technology. The project began when the OS team had trouble finding a claims system with the highest level of performance for the best price.

Says Zindl, “We wanted a system that would eliminate denials, provide quicker payments and shorten the claim cycle. We wanted customizable edits and warnings. We wanted reporting capabilities we could actually use and features that worked. Finding the right technology proved next to impossible. So we built it ourselves.”

As the HIMSS study concludes, denial reporting is not enough.  The ability to take action from the denial data to eliminate future denials is key to A/R success.  The process is as important as the technology itself, because software tools alone do not fully automate denials management and there are still issues such as working with payers and adjudicating claims.

For this reason, systems like efficientC have proven successful in eliminating denials. “It’s the product coupled with the service they provide that really makes it work well,” says Leigh Ann Collins, Director of Hospital Billing at ProHealth Care. “OS gives us real-time feedback on any issues or things that we can improve upon so we get those claims out right the first time and get paid quickly.”

Read OS Director of Product Strategy & Development Pat Curran’s thoughts on why changing revenue cycle systems is so hard.