When it comes to denial management, there is no “one-size-fits-all” approach.
Different organizations use different systems, departments, metrics, third-party vendors, and technology to guide and manage their approach to denials. As technology and data-tracking capabilities have advanced, however, denial prevention has risen to the forefront as a strategy that not only addresses denials but prevents them from happening in the first place.
Unfortunately, however, far too many healthcare organizations are still using the traditional “follow-up method” of denial management, in which claims are moved quickly through the process and onto the payer as fast as possible.
These providers zero in on their clean claim rate (percent of claims not stopped by internal edits before submission) as the most important indicator of success and simply wait for the payer to tell them what’s wrong with each claim.
Although these providers may have a spectacular clean claim rate, their rate of denials can still be astronomical because their denial management efforts happen on the back end once claims have already been denied.
As a result, claim denials continue to increase along with the cost to collect and the length of the payment cycle.
This article aims to quantify the cost of denials and give organizations an actionable roadmap for denial management that is based on data and prevention rather than follow-up and reactivity.