2 min read

RCM Pro Tip: Reduce Insurance Denials

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Revenue cycle benchmarks show denials are up, from $3.9 million in 2011 to $7 million in 2017. It’s critical for hospitals to focus on insurance claims denials, drilling down to find the root cause of every denial.

Here's five to reduce your healthcare organization's insurance denials:

  • Focus on improving your first pass payment rate by identify the most common denials and focus on eliminating them whenever possible.

  • Assign dedicated A/R staff to addressing denials as soon as they occur and track your hospital’s effectiveness at resolving denials. Monitoring denial resolution rates and appeal success rate will help you determine which denials and appeals are worth pursing and when you should cut your losses.

  • Examine revenue cycle workflows and identify what processes are leading to denials. Look at all departments. Work with department leads to train and educate everyone on the importance of their contribution to the revenue cycle and show them how to improve their performance.

  • Patient registration continues to lead denials of hospital insurance claims, so make sure to use tools to help improve the quality of billing data. But more importantly, invest in training the patient access department on the payer requirements to ensure proper and timely reimbursement.

  • Strengthen coding and billing activities with strong clinical documentation. Push providers for timely and accurate medical documentation so that coding staff can quickly and accurately code services and get bills into the system.

Rural hospitals face many challenges from increasingly complex insurance company policies that result in claim denials, underpayments, and “lost” claims. Hospitals stand to lose millions unless they take action now. Hospitals that meet those challenges head-on with improved processes for patient collection across all departments will prosper in the new culture of healthcare collections.

If your business office hasn't invested in a denial management product that provides insights and actionable data to reduce denials, it’s time to start shopping.