No medical practice likes a high denial rate. Not only does it negatively impact your practice's revenue cycle, but it makes things more difficult and frustrating for your patients, too. So what are some tips for minimizing denials? This post goes over some of the most common causes for denied claims and can help you get back on the right track.
Back in March, we talked about how the role of the pharmacist in the healthcare ecosystem has been expanding over the past decade. In addition to simple medication fulfillment, pharmacist now complete crucial patient aftercare, education, and vaccination administration. Many believe as the role of the pharmacist expands, they could become the key to reducing all kinds of healthcare costs. Here are three ways pharmacy is helping save costs for healthcare.
Denied claims cost healthcare organizations a lot of money each year. Often times, the denials could have been easily avoided. Let's look at the anatomy of a denied claim.
Claims get denied for a variety of reasons - some of them are extremely simple to remedied, while others may require entire shifts in your organizational structure. The question is, could any of them been prevented? Many claim denials are completely avoidable - and in fact there are practical ways you can combat claim denials. Look at the following common claim denial reasons and see if any of them have happened to you recently.
The AMA reports that up to 5% of claims are denied, and that number is only expected to rise (perhaps by as much as 200%) with the initial implementation of ICD-10 later this year. Medical billing and coding, which is undergoing enormous changes with the implementation of ICD-10, is always an area where additional training for staff can be a positive investment in denial management. Providing continuing education for coders can help them be better prepared to identify potentially problematic documentation, and be able to code with the highest level of accuracy. It’s often been said that the best defense against denials is — frankly — avoiding denials, but if that’s proving uneasy, if it seems to be near-impossible, the next best defense is to do a root cause analysis so that you understand why the denials continue.
Unfortunately, claim denials are simply unavoidable. Even the best practices have at least a 5% denial rate. So how do you reduce denials to the lowest possible percentage to keep your revenue cycle strong? The first step is understanding where and why denials happen in the medical billing world.
What do we actually mean when we talk about price transparency in healthcare? When we talk about healthcare costs, what does cost mean to each individual stakeholder?
When it comes to procuring and maintaining your contracts with payers, there is perhaps no skillset greater to possess than that of the art of negotiation. In today’s healthcare market, there’s not only a need to be informed and competitive, but healthcare organizations need to have a very clear understanding of where they stand amid the competition.
When searching for ways to improve your internal revenue cycle, it can be difficult to know where to begin. And in the fast-paced world of healthcare, you might not have even thought about taking the time to pause and look introspectively at your operations as a way to improve the revenue cycle.
One of the most talked about aspect of healthcare reform is the changing payment taxonomy which will dictate how payers and patients pay providers for services. The ongoing struggle to contain healthcare costs, which have been spiraling out of control for decades under the unsustainable fee-for-service model of payment, is likely a long while away from being corrected in toto. At this stage in the game, even a little progress in a direction towards savings is reason for hope.