Hospitals are losing an estimated 3% of net revenue on denials and the cost of reworking claims is an average of $25 per claim. Hospitals are renewing their focus on denial management by analyzing their current processes and tweaking those gaps. Taking another look at your processes, workflows and automated tools significantly helps your organization’s bottom line:
- Analytics are crucial. Having a tool that allows providers to quickly view opportunities for improvement.
- Closing registration/pre-service gaps in your processes and workflows can immediately increase revenues. In fact, 30 – 40% of denials are the result of registration and pre-service errors. A well- defined process coupled with automation (ex: eligibility, authorization, patient estimation), and moving the process to the front end of revenue cycle significantly reduces denials on the back end.
- Pre-authorization is another source of denials. If there is not a well-defined process in place or an automated tool, revenue leakage will continue.
- Collaboration and cooperation with revenue cycle staff and clinical staff can streamline the process. More often than not, clinical staff rarely sees reports on denials and are not being asked for input on how to improve processes. Operational reports from finance and revenue cycle should be reviewed by clinical staff at which time their input should be requested. This can help in streamlining the process and closing some of those gaps.
The good news is that a significant percentage of these denials are recoverable. Parathon can provide added value to your processes as well as business office services to supplement for efforts. For more information on our services, please visit our website at www.parathon.com.