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 wallets. 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

Often, inefficient manual processes and a lack of accurate data lead to the staffing office team and unit managers making desperate phone calls to find staff to fill critical open shifts at the last minute. Without predictive analytics to foresee when understaffing will be an issue and without the tools to do mass outreach to staff who are qualified to work the shift, the process becomes reliant on haphazardly prepared calling lists and large numbers of phone calls. The staffing office and unit managers spend valuable time on the calling efforts, and nurses become frustrated with the frequent calls that disrupt their personal time and add unneeded job-related stress.

Taking advantage of push notification capabilities can eliminate this problem. Managers and staffing coordinators identify the staff who are qualified to fill the open shifts and send notifications to those who are eligible. Staff can elect to receive the information via text, email, or within the mobile app.

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.

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