The Medical Group Management Association actually put a price tag on the cost of managing each denial in your organization’s denial queue: $25-$30 a piece. That cost adds up when you consider that up to as many as a quarter of all claims get denied - meaning that for some hospitals, that $25 per claim price tag could become overwhelming pretty quickly. The first step in the case of any denied claim is determining why it was denied.
When we talk about revenue cycle management systems it’s easiest to draw comparisons to physicians working in an ambulatory setting. This setting allows for accurate and timely charge capture of fees by their electronic medical record system. However, their inpatient counterpart physicians are less likely to reap the benefits of the EMR’s billing functions - if they’re reaping the benefits of an EMR at all.
A claim could have been denied for many reasons, 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:
If you have a higher percentage of claim denials in your organization than you are comfortable with, you’re probably long over due for a close look at what is driving these denials up - and I hate to be the one to tell you, but it’s not the payers! Top 4 Reasons Why Your Claims are Denied 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.
Understanding the revenue cycle can be tricky for many of us who work in healthcare. Unless we are directly involved with patient accounts, the subtleties of the process may be lost on us. That is, until we find ourselves patients - at which point even the most minute details of the process evident to us. If we want to get a clear view of the process in its entirety, and how we can improve at each step of the way, it’s often easiest to look at it as a continuous process which is always initiated by patient registration.
Claim denials are one of the largest areas of lost revenue for health care organizations. They are also one of the simplest things to quantify, address and correct. Reducing denials is a valuable way to increase profitability amidst the difficult financial situation organizations face due to things like Medicare cutbacks and lower reimbursement rates. Targeting denied claims can directly benefit your organization’s bottom line by recouping lost revenue and accelerating your revenue cycle.
It is no secret many hospitals are struggling with their revenue cycle and less than stellar bottom lines. Healthcare reform, ICD-10 implementation...