Stuck in a River of Denials?

The $30Billion Question
See Fewer Denials and More Revenue in 5 Easy Steps

For many healthcare businesses, denials remain a constant flow of lost revenue and lost time. Few other elements related to the business of healthcare have generated as much buzz and frustration as denial management over the past decade. The topic has been scrutinized, and the results have produced scores of promising electronic solutions that can help slow the current of lost revenue. But, the already complex tasks involved in healthcare payment are growing more complex, creating potential pitfalls in processes that used to be efficient.

Hospitals and healthcare groups are in a difficult situation when it comes to decreasing the financial and time losses created by denials. Increased regulatory demands, fluctuations in coverage by payers and staff turnover are often the biggest obstacles in improving denial management. Fixing these issues requires administrators and staff at all levels to coordinate set procedures and create the safeguards that catch mistakes before they cause a problem. To help, here are 5 easy steps you can implement to help reduce the occurrence and the impact of denials on your healthcare business:

1. Take no coverage for granted.
Always check a patient's health plan to verify eligibility and benefits before every procedure. Health plans change constantly these days, so care that may have been covered a few months ago could be dropped from the plan by today. The most efficient method is to use real-time electronic solutions that can connect to all of your payers from one system. If you don’t have that option, you can still pick up the phone or surf to multiple payer websites. Any way you can verify eligibility, this ounce of prevention up front is one of the most effective ways to minimize denials downstream.

2. Check for secondary coverage.
Secondary and supplemental insurance plans have become more common with the popularity of Consumer-Directed Health Plans. As a result your staff should be diligent during the registration process so that they collect relevant information on all available payment options.

3. Do everything reasonable to prevent staff turnover.
No matter how thorough a staff member's training, the intricate details of correcting and properly resubmitting a denied claim take time to learn. The longer an employee is with your organization the more productive they will probably be in many areas, including registration and denial management.

4. Consider creating an incentivized department specifically for denials.
This department can vary significantly in size depending upon the scale of your organization, but when dedicated staff work on resolving denied claims on a daily basis, they develop nuanced skills and understanding that normal business office staff wouldn't have the time to cultivate. Having a dedicated denial management department can also help you spot over-arching trends and take pro-active measures to reduce future denials.

5. Investigate automated solutions.
Automated denial management solutions can connect with your claim management to create automated checks that quickly identify errors while accurately accounting denied and adjusted amounts. Automated denial management solutions can simplify the entire process so that your organization gets the greatest mix of revenue and efficiency.

These 5 easy steps will help get your healthcare organization flowing in a strong current of better denial management, but they're only the beginning. Every organization contains different people and different procedures, so it's incredibly important that you implement the changes that are best for your situation. Make sure your staff and any other impacted parties are on board with prospective changes and keep the lines of communication healthy. If everyone is paddling in unison towards the same goal you may be surprised by how much time and money you'll save with improved denial management in your healthcare organization.

To find out more information and see how Emdeon can assist you in your denial management process, call 877.EMDEON.6 (877.363.3666) or visit us online.