Decoding 5 Step Denial Strategy

It's time to overhaul outdated practices and take a proactive stance in preventing denials, minimizing bad debt, and safeguarding your revenue. Embrace a comprehensive five-step strategy, supercharged with intelligent automation, to uncover denial pain points and fortify your revenue cycle. This approach also streamlines patient access, elevating both staff and patient satisfaction.

1. Unlocking Denial Insights: To conquer denials, it's vital to decipher their origins and frequencies. Dive into a thorough analysis of your 837/835 claims and payer remit data, ensuring it aligns with your local demographics and payer profiles. This granular understanding helps pinpoint where denials are costing your revenue the most.

2. Data Precision: The foundation of revenue success lies in precise data. Ensure registrations are flawless to enhance financial performance and maintain a steady cash flow. Harness technology to conduct quality assurance audits on 100% of patient accounts, flagging various errors. This empowers your staff by alerting them to issues and potential payment risks.

3. Advanced Insurance Verification: Go beyond demographics and audit eligibility and benefit-level responses for inaccuracies. Implement technology that serves as an all-payer eligibility clearinghouse, delivering tailored responses for preempting denials. This sophisticated tech scrutinizes response data, considering demographic details, policy numbers, group numbers, and specific benefits information, including coordination of benefits (COB). It guarantees that requests are routed to the optimal payer for maximum reimbursement.

4. Elevate the Patient Financial Experience: A seamless patient journey relies on precise data and real-time eligibility transactions. This solid foundation allows for accurate cost estimates. Technology should encompass payer contract terms, chargemaster rates, service-specific benefits, co-pays, and real-time deductible balances. Understanding patient payment propensities equips your staff to offer tailored solutions, such as payment plans or financial assistance opportunities, beyond collecting co-pays. Additionally, offering patients convenient one-touch payment options at every interaction maximizes your revenue.

5. Streamline Prior Authorization: The cumbersome prior authorization processes can be streamlined to save time and resources. Leverage solutions that navigate complex payer portals, rules, and requirements, automating the determination, submission, and retrieval processes. This reduces costs, eliminates no-authorization denials, and ensures timely patient care.

Incorporating these steps into your denial management strategy not only reduces denials but also optimizes your entire revenue cycle. This approach safeguards your finances, saves valuable time and resources, and ensures your revenue cycle operates at peak efficiency.

References: AccuReg

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