April 24, 2018
Claims denials represent millions of dollars in lost net revenue for hospitals and health systems, with up to 7% of submitted claims being denied in an average hospital on a routine basis. However, implementing claims denial management software can seem like an overwhelming task. Claims denial management consultants can help locate the biggest problem areas for a short-term, high-impact project.
We spoke with Tim Bavosi, General Manager of Healthcare Revenue Strategies, a RevSpring company, on what CFO’s can expect to gain from an audit and ongoing support from a consulting firm. His group specializes in revenue cycle management consulting.
Where are most claims denials coming from? We find that most denials are a result of registration errors, such as eligibility, authorization, or missing data.
Are these errors usually the result of a staff training issue or a payer issue? Most denials can be tracked back to a “user error” or “technical error” (i.e. missing charges, invalid sequence of procedures (Medical Necessity), non-credentials NPI #, missing NDC #, missing occurrence code(s), invalid diagnosis, and so on). Over 90% of denials fall into one of three root causes:
What are some examples of what an audit is and how has it improved denials? A standard assessment covers two areas of focus:
If denials aren’t properly managed, what are the impacts to the patient during the billing experience? Depending on the denial, for example, a high percentage of eligibility denials are erroneous – meaning the patient has insurance but bad data entry, missing information, spelling errors, or name discrepancies will cause the claim to deny.
In order for any “Denied Claim” to be paid, the claim must be re-worked manually by a biller then re-submitted to the payer. This scenario can impact the patient as follows:
There are 1600+ CAS reason codes that represent different ways payer cans deny claims. Certain ones are much more prone to impact patients than others.
How long does a typical assessment last? Our standard engagement is approximately six to eight weeks, and systems can implement changes to see positive results immediately.
If you’d like to learn more about our revenue cycle management consulting, we’d love to help you. Contact us to see how our comprehensive patient engagement and claims denial management services can help your organization meet your goals, or connect with us on Twitter, LinkedIn, or Facebook to learn more.