3 benefits you’re missing out on if you’re still using multiple claims management systems

We live in a world where technology seems to connect just about everything. At home, we ask Google to turn on the lights and wake up our kids. On the way to work, we ask Siri to place our favorite drive-through order from Starbucks. Our personal lives are jam-packed with a wide range of sophisticated devices and services that are all connected, each making life a little bit easier.

So, doesn’t it feel strange to sit down to work and have to log on to multiple claims systems or portals, remember several usernames and passwords, and toggle between tabs and screens? Haven’t we moved beyond such cumbersome, outdated, disparate workflows? Truth is, work applications should be as seamless and connected as the apps we use in our personal lives.

Working together to create a powerful, integrated experience, ABILITY EASE All-Payer and ABILITY EASE Medicare deliver the market’s first all-payer system that integrates both government and commercials claims workflows and access. As a single, connected platform, it transforms your revenue cycle management to maximize efficiency, save time and lead to quicker turnarounds for reimbursement.

If you’re still using multiple claims management systems, you are probably missing out on:

1. Single sign-in access to all payers

A single platform integrates clearinghouse functionality, direct payer connections and DDE-scraping technology, allowing providers of any size to manage every claim from every payer, across all locations. That means that employees only need to log in once to submit, edit, track and manage all claims. No more passwords to remember, switching between screens, or wasting time logging in and out of sites.

2. Gold-standard clean claims

The cost of reworking denied claims is often a significant percentage of an organization’s revenue cycle expenses. And, as many as 60% of claim denials are never even corrected and re-submitted for reimbursement!1

With a single platform featuring robust scrubbers with the most up-to-date CMS and commercial payer rulesets, plus facility-specific, customizable rules, organizations can achieve a 99% or greater clean claims rate.2

3. Fast & simple claims resolution

If a claim is rejected by a payer, resolution, resubmission and turnaround times can really hamper time-to-reimbursement.

When billers only need to focus on a single dashboard for all claims management, it’s easy for them to see the claims issues that require immediate attention. Click-to-fix corrections and direct resubmissions (in other words, no Medicare waiting period) ensure that mistakes don’t impact your bottom line.

It’s time to stop jumping between applications and realize the productivity boost and time savings of a one-stop, all-claims platform. Discover how ABILITY’s integrated approach can transform your revenue cycle.


1. “Why getting claims right the first time is cheaper than reworking them,” Timothy Mills, Physician’s Practice, September 9, 2019, https://www.physicianspractice.com/view/why-getting-claims-right-first-time-cheaper-reworking-them

2. ABILITY internal reporting, ABILITY EASE All-Payer, November 2020

ABILITY and design®, ABILITY® and ABILITY EASE® are trademarks of ABILITY Network, Inc.

How SNFs use technology to increase efficiency and improve resident experience

Skilled nursing facilities have been using ABILITY applications for more than a decade to increase efficiency, improve resident outcomes, ease reporting compliance and maximize reimbursements. ABILITY Network President and General Manager Bud Meadows recently provided insight in an interview with Skilled Nursing News as to how ABILITY has worked to understand the operations and needs of SNFs to create products that automate and ease clinical and administrative processes.

Meeting the administrative and clinical needs of SNFs

ABILITY has come a long way since its original platform, which simply connected providers to Medicare. Through evaluations of those transactions, it expanded to clinical and administrative areas that have made it a leader among skilled nursing facilities. With well-honed discipline, project management, distribution, development and support, ABILITY created a scalable system to support SNFs of all sizes. Today, our applications are used by more than 50,000 healthcare facilities.

Simplifying workflows

ABILITY understands that the SNF workflow doesn’t happen in isolation; residents most often present from hospitals that have separate workflows. By understanding the processes involved with SNF admissions, ABILITY automates the manual processes involved to make the transition from a hospital to a SNF simpler and more efficient. Because the administrative and clinical processes play a role in the quality of patient care, ABILITY applications automate both workflows.

Post-acute focus

Though ABILITY supports Medicare providers of all types, it maintains a special focus on post-acute facilities through applications that complement EHRs. Through that focus, ABILITY has forged meaningful partnerships with post-acute providers, enabling the development of products that meet the needs of those facilities.

Overcoming the challenges of the COVID pandemic

With the outbreak of the COVID pandemic, skilled nursing facilities faced a heightened need for infection monitoring and reporting. ABILITY INFECTIONWATCH became a go-to tool for tracking during the public health emergency. The application allows for easy reporting of COVID tests, cases and vaccinations. ABILITY INFECTIONWATCH – as well as ABILITY CAREWATCH – also allow facilities to track and manage quality measures for quicker identification of PDPM components to better capture revenue opportunities.

To gain more insight into how ABILITY supports SNFs, read the full Skilled Nursing News article.


ABILITY and design®, ABILITY®, ABILITY INFECTIONWATCH® and CAREWATCH® are trademarks of ABILITY Network, Inc.

How to optimize your clinical data for SNF surveys and PDPM reimbursement

A lot has happened since last summer when CMS issued guidance for surveys and enhanced enforcement around infection control at skilled nursing facilities. The regulatory agency also authorized states to expand survey activities to include more routine surveys upon entering phase 3 of the nursing home reopening guidance or earlier at state discretion.

With the renewed attention on the issues of quality and oversight, most states have now resumed their standard nursing home inspections alongside focused infection control surveys.

From keeping up with regulatory changes and avoiding deficiencies to managing PDPM and Five-Star Ratings, you have a lot on your plate. Without a doubt, survey preparedness and accurate quality data are paramount to compliance and proper reimbursement.

Fortunately, you don’t have to go it alone – ABILITY is with you every step of the way! We continuously make software improvements to help post-acute facilities better manage quality and keep up with the latest regulations.

We have integrated some exciting new features into ABILITY CAREWATCH that help SNFs optimize their clinical data for surveys and PDPM reimbursement in a post-COVID world. These enhancements include:

  • A built-in PDPM Calculator enables you to ensure proper reimbursement and maximize revenue potential. You can use it to identify the reimbursement and care level of each patient, decide whether to submit an Interim Payment Assessment (IPA), and make strong clinical and financial decisions related to your patient population and potential admissions.
  • The Survey Watch page now uses data sourced from Nursing Home Compare (NHC), giving you the most up-to-date survey data to prepare for surveys. NHC data is updated monthly, whereas the previously used OSCAR data is only updated on a quarterly basis.
  • The CMS SNF Survey Report has a new user interface that offers data export functionality and allows you to expand and collapse details for different types of surveys to facilitate data comparison and analysis.
  • The Focused Survey Report has been updated with the new user interface that features data export functionality. It also allows you to use colored checkmarks to differentiate manual report changes.

With ABILITY CAREWATCH, you always have the right quality management application at the right time!

Discover more about how you can position your facility for PDPM and survey success right here.


ABILITY and design®, ABILITY® and CAREWATCH® are trademarks of ABILITY Network, Inc.


Long-term care facilities now required to report COVID-19 vaccinations under new CMS rule

Long-term care facilities must now have programs in place to deliver COVID-19 vaccinations to all residents and staff who wish to receive them and provide information on the benefits of the vaccine, according to an interim final rule announced earlier this month by the Centers for Medicare & Medicaid Services (CMS)1.

The interim rule also mandates that facilities report staff and resident vaccinations weekly to the Centers for Disease Control and Prevention’s National Healthcare Safety Network (NHSN). The information garnered through the reporting will help to identify facilities that require additional support in providing education and vaccines.

COVID-19 vaccination reporting requirements

COVID-19 vaccination reporting requirements apply to long-term care facilities, as well as intermediate-care facilities for individuals with intellectual disabilities. The new requirements are in addition to existing requirements to report COVID-19 testing, case and mortality data to the NHSN. They mirror existing reporting requirements for influenza and pneumococcal vaccines for long-term care facilities and carry similar penalties for noncompliance2 – $1,000 for the first failure to report and $500 per week for each subsequent failure.

Reporting requirements apply to all residents, as well as staff who work regularly within the facility.

Benefits of reporting vaccination data

According to CMS1, tracking of COVID-19 data will allow NHSN to identify facilities that need additional support in providing vaccinations and vaccine education to residents and staff. That support is especially important, CMS officials said, because of how hard hit residents and staff of Long-Term Care Facilities have been by COVID-19 infections and deaths. CMS officials also acknowledged that staff turnover at long-term care facilities can make effective vaccine programs a challenge, with programs requiring additional vaccine efforts as new staff members come on board.

Leveraging technology for easier vaccine reporting

Though the new reporting requirement places added burden on often short-staffed teams, technology can help facilities comply with the new rule and avoid penalties. ABILITY INFECTIONWATCH provides for easy reporting of COVID-19 vaccination data. The application enables COVID-19 vaccination reporting with:

  • Single-button access to accurate vaccination data for residents and staff
  • Exportable Excel/CVS files for quick copying and pasting of line listings and antibiotic usage reports available into NHSN templates
  • Tracking of what has and has not been reported to NHSN
  • A centralized hub for all vaccination data

Learn more about how your long-term care facility can meet COVID-19 vaccination reporting requirements with ABILITY INFECTIONWATCH.


1. CMS Expanding Efforts to Grow COVID-19 Vaccine Confidence and Uptake Amongst Nation’s Most Vulnerable,” Centers for Medicare & Medicaid Services, May 11, 2021, https://www.cms.gov/newsroom/press-releases/cms-expanding-efforts-grow-covid-19-vaccine-confidence-and-uptake-amongst-nations-most-vulnerable
2. Flynn, Maggie, “CMS Requires Nursing Homes to Report Staff and Resident COVID-19 Vaccination Status,” Skilled Nursing News, May 11, 2021, https://skillednursingnews.com/2021/05/cms-requires-nursing-homes-to-report-staff-and-resident-covid-19-vaccination-status/


ABILITY and design®, ABILITY® and ABILITY INFECTIONWATCH® are trademarks of ABILITY Network, Inc.

How a SaaS-based scheduling system can help overcome the healthcare staffing crisis

Caregiver shortages and high turnover rates are growing concerns across the country. At the center of the looming crisis, healthcare organizations do not have the luxury of taking a wait-and-see approach to addressing the issue. In spite of having a workforce and a bottom line that have been battered by the burdens of the pandemic, healthcare leaders must quickly develop staffing strategies that alleviate the effects of an increasingly alarming shortage of nurses and direct care workers.

Determining the best course of action to take can seem daunting when your organization has a tight budget and limited resources but needs to see results quickly.

These circumstances call for ABILITY SMARTFORCE Scheduler, a powerful staff scheduling application built on a SaaS delivery platform. Here are the system criteria that enable our scheduling application to deliver value quickly, effectively and affordably:

  • Fast deployment – In today’s environment, your health system cannot afford to spend months or even years working on a system rollout. With an implementation time averaging just two weeks, your health system can quickly overcome staff scheduling challenges.
  • Low cost – With no need for an investment in expensive hardware, your initial costs and cost of ownership are low. This is an investment that delivers a positive impact without a heavy toll on your time and resources.
  • Easy maintenance – We maintain the system for you, eliminating maintenance demands, human resource requirements and overhead costs for your organization.
  • Cost savings – The technology enables you to optimize your staff across the enterprise, ensuring all employees are working up to their commitments. By containing overtime and agency costs, your investment quickly pays for itself.

As the population ages and care demands increase, the need for bedside nurses and direct care workers will continue to grow. Already, healthcare organizations are struggling with position vacancies and schedule gaps. At the same time, budgets are tight and resources are limited, making it difficult to take action to address the staffing crisis.

The workforce challenges for healthcare organizations grow in complexity, and ABILITY continues to deliver scheduling technology that supports the innovative staffing initiatives your organization needs. These build a vibrant, healthy, empowered workforce while also managing overtime and turnover costs.

To learn more about practical strategies for leveraging technology to protect the stability of your workforce and build organizational resilience, check out our new eBook, “The High Cost of Doing Nothing: Why Ineffective Scheduling Methods Must Be Overcome Now.”


ABILITY and design®, ABILITY® and ABILITY SMARTFORCE® are trademarks of ABILITY Network, Inc.

With permanent Medicare coverage, telehealth is here to stay

Is your healthcare organization ready for the virtual revolution? Last year, the healthcare market widely embraced telehealth services to help patients who were quarantining and practicing social distancing. Many practices, however, viewed virtual appointments as a stop-gap to help provide continuous care through the pandemic. As a result, a lot of healthcare organizations have been using legacy conferencing technology and other outdated solutions.

Let’s explore three indicators that telehealth is here to stay: Medicare reimbursements, patient demand and telehealth technology that does more for patients and providers.

Medicare makes telehealth reimbursements permanent

The Centers for Medicare & Medicaid Services (CMS) has confirmed that Medicare will continue to reimburse for 45% of currently covered telehealth services permanently. According to CMS, these services include, “standard evaluation and management visits, group psychotherapy, neurobehavioral status exams, and short home visits.”1

This isn’t the first time CMS has acknowledged the longevity of telehealth services across healthcare markets. Former CMS Administrator Seema Verma said, “I think the genie’s out of the bottle … it’s fair to say that the advent of telehealth has been just completely accelerated, that it’s taken this crisis to push us to a new frontier, but there’s absolutely no going back.”2 Continued, permanent Medicare coverage for most telehealth appointments and services is a strong indicator that telehealth will continue to grow.

Patients want expanded telehealth appointments

Beyond reimbursements, there’s a significant demand from patients for continued virtual services. In a recent study, 71% of patients reported that they’d consider telehealth appointments with their existing provider – and more than 50% said they’d see a new provider who offered telehealth services.3

Patients are primed for virtual appointments and online scheduling – making now the perfect time to evaluate your telehealth platform. Does it provide HIPAA-compliant telehealth services, or have you been relying on a stop-gap solution that isn’t designed specifically for patients’ privacy needs? Can you easily add attendees on the fly, conduct group visits and share screens?

Discover telehealth that does more

From permanent Medicare reimbursements to patient demand, telehealth is here to stay. The right telehealth technology can help you serve more patients without overburdening providers and staff. By using the ABILITY Virtual Care application, for example, you can ensure security and privacy for patients while streamlining scheduling tasks. This innovative software allows group visits and screen sharing to enhance the patient experience. Plus, capabilities to add attendees on the fly can save time and reduce missed appointments.

Discover telehealth that does more – for you and your patients. Schedule a demo of ABILITY Virtual Care today.


1. “CMS Finalizes Meaningful Expansions of Medicare Telehealth Service Coverage Through 2021,” Kristin Allen, CMS, December 14, 2020, https://www.healthmanagement.com/blog/cms-finalizes-meaningful-expansions-of-medicare-telehealth-service-coverage-through-2021/

2. “’The genie’s out of the bottle on this one’: Seema Verma hints at the future of telehealth for CMS beneficiaries,’ Laura Dyrda, Beckers Hospital Review, June 3, 2020, https://www.beckershospitalreview.com/telehealth/the-genie-s-out-of-the-bottle-on-this-one-seema-verma-hints-at-the-future-of-telehealth-for-cms-beneficiaries.html

3. “Four new statistics that prove that telemedicine isn’t just a pandemic fad,” Andrei Zimiles, Medical Economics, July 8, 2020. Accessed March 3, 2021 at https://www.medicaleconomics.com/view/four-new-statistics-that-prove-that-telemedicine-isn-t-just-a-pandemic-fad

ABILITY and design® and ABILITY® are trademarks of ABILITY Network, Inc.

Celebrating healthcare heroes during Nurses Month

Happy Nurses Week and Nurses Month! After the courageous and tireless efforts of nurses over the last months, it’s so appropriate to have Nurses Week expanded to Nurses Month. We’re excited to spend the month of May celebrating, recognizing and thanking nurses – our real-life superheroes.

We’re honored to be able to support nurses by providing smart scheduling and credentialing systems that enable you to protect, value and empower your nurses. These tools support strategic staff scheduling initiatives that can help you overcome pressing challenges, such as staffing shortages and turnover.

A better work/life balance

ABILITY SMARTFORCE Scheduler makes it easy for front-line staff to be involved in the scheduling process. With more control over their own schedule, nurses can balance their time and energy to ensure they can fulfill both personal commitments and work demands with less stress or threat of burnout.

These positive effects on nurses’ well-being are especially valuable now because the pandemic has taken a toll on healthcare staff. According to the American Nurses Foundation’s COVID-19 Impact Survey, the top four feelings nurses have experienced in the last 14 days are exhausted (51%), overwhelmed (43%), irritable (37%) and anxious/unable to relax (36%).1

A better work environment

Another important way scheduling systems benefit healthcare staff is by supporting a safer, more collaborative work environment. Here are a few ways that ABILITY SMARTFORCE Scheduler helps create a more positive workplace for nurses:

  • Predictive analytics ensure that nurses and patients are aligned appropriately so nurses have balanced, equitable workloads.
  • Streamlined open shift management workflows and mobile tools foster schedule collaboration between unit managers and front-line staff.
  • Mobile “shout-out” functionality makes it easy for leaders to recognize staff members for teamwork, extra efforts and key events, such as their birthday or work anniversary.
  • Credentialing software makes it easy to pair the right nurse with the right patient while enabling nurses to work to the top of their license.

Creating workforce stability

While nurses are healthcare superheroes, they are not invincible. Nurses and direct care workers are facing burnout, which is exacerbating staffing shortages and turnover issues. So, while we celebrate nurses, it’s also critical to consider how we will stabilize and safeguard the healthcare workforce.

If your organization isn’t taking action to address these challenges, you’re losing ground. For ideas about practical steps you can take to have a meaningful impact on staff morale, check out our eBook, “Seven Staffing Strategies that Value, Protect and Optimize Nurses.”


1. “Pulse on the Nation’s Nurses COVID-19 Survey Series: Year One COVID-19 Impact Assessment Survey,” American Nurses Foundation, February 2021, https://www.nursingworld.org/practice-policy/work-environment/health-safety/disaster-preparedness/coronavirus/what-you-need-to-know/year-one-covid-19-impact-assessment-survey/

ABILITY and design®, ABILITY® and ABILITY SMARTFORCE® are trademarks of ABILITY Network, Inc.

How new legislation and policies impact SNF infection prevention and control

The American Rescue Plan of 2021, which includes resources for skilled nursing facilities (SNFs), was signed into law in March. And in April, the Centers for Medicare & Medicaid Services (CMS) issued its Fiscal Year (FY) 2022 Skilled Nursing Facility Prospective Payment System Proposed Rule (CMS 1746-P), which includes two new Quality Reporting Program (QRP) measures.

After a tumultuous year, skilled nursing facilities are undoubtedly concerned about legislation and policies that affect their Infection Prevention and Control programs.

Here’s what you need to know about these recent changes.

How the new stimulus bill supports SNFs

The American Rescue Plan of 2021 was signed into law to support the country’s recovery from the economic and health effects of the COVID-19 pandemic. The $1.9 trillion relief package includes the following provisions to enhance infection control support at SNFs:

  • $200 million for quality improvement organizations to provide infection control and vaccination uptake support
  • $250 million to states to deploy “strike teams” (i.e., groups of public health, infection control and emergency response personnel) to assist with clinical care, infection control or staffing for up to one year after the COVID-19 emergency period ends
  • $8.5 billion added to the Provider Relief Fund for rural health care providers, including nursing homes, enrolled in Medicare or Medicaid that provide COVID-19 diagnosis, testing or medical care

Understanding the two new QRP measures

On April 8, 2021, CMS issued a proposed rule that included updates to the Skilled Nursing Facility Quality Reporting Program (SNF QRP). The rule includes two new quality measure proposals slated to begin FY 2023:

  1. Skilled Nursing Facility Healthcare-Associated Infections Requiring Hospitalization

The goal of this outcome measure is to identify SNFs with notably higher rates of healthcare-associated infections (HAIs) resulting in hospitalization, in comparison to peers. This proposed measure uses claims data to estimate the risk-adjusted rate of HAIs acquired during SNF care which result in hospitalizations.

The measure targets all infections that are serious enough to require admission to an acute care hospital. It is risk-adjusted to “level the playing field” and to allow comparison of performance based on residents with similar characteristics between SNFs.

  1. SARS-CoV-2 Vaccination Coverage Among Healthcare Personnel

This process measure tracks COVID-19 vaccination coverage among healthcare personnel (HCP) in many provider facilities, including SNFs. The measure will be used to assess whether SNFs are taking steps to limit the spread of COVID-19 among their staff, residents and local communities.

The measure quantifies the cumulative number of HCP eligible to work in the facility for at least one day during the reporting period and who received a complete vaccination course against SARS-CoV-2 since the date vaccine was first available. HCP with contraindications to SARS-CoV-2 vaccination are excluded.

SNFs will report vaccination data through the Centers for Disease Control and Prevention National Healthcare Safety Network beginning FY 2023. Facility-level COVID-19 HCP vaccination rates will be published on Care Compare.

Streamline infection prevention and control

ABILTY can help you make the most of relief funding and stay on top of regulatory changes. With ABILITY INFECTIONWATCH, your SNF team can closely monitor infectious disease outbreaks, track infection prevention and control strategies and simplify regulatory compliance. Discover how ABILITY INFECTIONWATCH can streamline infection surveillance and management at your facility today!


ABILITY and design®, ABILITY® and ABILITY INFECTIONWATCH® are trademarks of ABILITY Network, Inc.

Empower nurses – and boost retention – with 7 practical strategies

Even before the pandemic pushed the healthcare industry to the brink, the U.S. was already facing a massive shortage of nurses, with a deficit of over 900,000 nurses projected by 2030.1

At the same time, never has it been clearer that nurses are at the cornerstone of patient care, and it goes well beyond just fulfilling the duties of the job. This past year, during a time full of upheaval and uncertainty, nurses largely proved that they are reliable, resilient and committed to their work, even sacrificing their own mental and physical health to put patients first. That’s why for the 19th year straight, nurses topped the list of most trusted professionals, according to a Gallup poll.2

As the vaccine distribution continues and society returns to “normal,” the focus must shift from mere survival to how to slow a looming exodus from the profession.

Praise and applause aren’t enough to reverse the shortage

Acknowledgement and celebration of nurses’ efforts are critical components for addressing job dissatisfaction, but it can’t stop there. Every day, nurses are still overworked, fatigued and teetering on the verge of burnout.

To address those issues, organizations must implement staffing processes that create a better work/life balance for their nurses – even if time and resources are limited right now.

7 practices that require minimal effort but offer maximum reward

Offer your nurses more balance and control to increase job satisfaction and morale with these simple, but practical, tips:

  1. Make staffing and scheduling collaborative. When employees are engaged in the process, they are generally more accepting of – and happier with – their schedules.
  2. Provide high-level visibility and real-time access that only technology can deliver. You need a quick and easy way to assess staffing conditions at any given moment. Plus, insights from data and analytics enable you to make proactive and in-the-moment decisions, reducing much of the frustration around staffing issues.
  3. Invest in a solution that is intuitive and delivers quick results. Now is not the time to bog down your organization by deploying a solution that is hard to learn, use or deploy.
  4. Provide staff with more stability. Adopt technology that enables you to forecast and adapt to staffing ups and downs, so nurses don’t feel like they are in a constant state of chaos.
  5. Focus on matching nurses with patient needs. Nurses appreciate equitable, balanced workloads.
  6. Streamline the open shift management process. Eliminate the stress around last-minute call offs and under-staffing by making it easy for your team to fill open shifts.
  7. Make the process more efficient for nurse managers. With less time spent on scheduling, nurse managers can focus on their staff and patients.

For more in-depth advice on how to align your staffing processes with nurse retention initiatives, download our eBook, Seven Staffing Strategies that Value, Protect and Optimize Nurses.

The right healthcare scheduling application at just the right time

With ABILITY SMARTFORCE Scheduler, you can easily update your staffing processes to help improve work/life balance, job satisfaction and morale, which can go a long way toward boosting retention.

  • Manage staff-to-patient ratios easily
  • Avoid costly inefficiencies and overtime
  • Forecast staffing needs to maximize accuracy
  • Empower staff with a collaborative approach

Learn more about ABILITY SMARTFORCE Scheduler.


1“United States Registered Nurse Workforce Report Card and Shortage Forecast,” Stephen P Juraschek, Xiaoming Zhang, Vinoth Ranganathan, and Vernon W Lin, The American Journal of Medical Quality. September/October 2019: 473-481, https://pubmed.ncbi.nlm.nih.gov/31479295/

2 “U.S. Ethics Ratings Rise for Medical Workers and Teachers,” Gallup, December 22, 2020, https://news.gallup.com/poll/328136/ethics-ratings-rise-medical-workers-teachers.aspx

ABILITY and design®, ABILITY® and ABILITY SMARTFORCE® are trademarks of ABILITY Network, Inc.

Three ways to simplify denial management and achieve cleaner claims

It’s no secret that it’s getting harder for healthcare organizations to get paid for their work. As a trusted provider, you are under increasing pressure to collect more money and cut operational expenses while continuing to provide top-notch care, especially during a public health emergency.

On top of that, you are also still faced with keeping your workforce safe and keeping the public protected while in your facility.

The following are three ways to strengthen your overall denial prevention and management process.

1. Analyze denial management and shift your thought process

While you may consider denials a reality of being in healthcare, it doesn’t always have to be that way. Of course, the recent downturn in the economy is causing patients as well as insurance companies to tighten their belts. And that directly impacts your A/R days and cash flow.

This increase in financial pressure is elevated throughout healthcare organizations, which are now forced to be creative and find alternative solutions. The good news is that you have more power than you think to prevent denials. It all begins with understanding reimbursement and compliance rules. This also extends to creating rules within your organization to foster excellent care through optimizing internal denial prevention and management programs.

2. Identify types of denials

Identification and analysis allow you to understand a denial’s root causes. You can then put a process or improvement in place so that the same problem doesn’t reoccur. In other words, it comes down to having a proactive approach to denial prevention.

When you can visualize denials by categories, it helps you create rules for your organization that work towards correcting denial reasons and categories. Once hard or soft denials occur, it can be challenging to get them overturned by the payer. Software from ABILITY helps you identify and understand the rule so that you can consistently follow it and prevent future denials.

3. Optimize your clean claims

Accurate, up-to-date information is a critical part of avoiding denials and achieving clean claims. That means that you need to have solid pre-registration, check-in, and intake processes in place. Preferably, the pre-registration process is happening prior to the patient’s visit.

Denial prevention starts with a clean claim. Be sure to validate all the required information prior to data entry so as many errors as possible are avoided from the start. Keep in mind the types of accurate information needed for an insurance company to process your claim correctly the first time. Doing so will help you improve clean claims and get paid more quickly.

Want to learn more about improving your denial management process?

Check out ABILITY’s free, on-demand webinar, Denial Management Made Easy, where RCM expert Kem Tolliver digs deeper into these important topics. By watching, you’ll get an in-depth look at several key terms and definitions, and common code sets that are integral to the denial prevention process. You’ll also gain access to additional resources to help you avoid claims denials.

ABILITY and design® and ABILITY® are trademarks of ABILITY Network, Inc.