Kaiser Family Foundation Revealed That 90% of Denials Are Preventable!
Denied claims are a leech on healthcare providers, sucking away resources and hindering cash flow. Studies from the Kaiser Family Foundation and Change Healthcare show that nearly 90% of denied claims are preventable.?
Yet, a staggering 50% to 65% are simply abandoned, leaving a significant chunk of revenue on the table. Factor in the added cost to rework a denied claim, estimated at $25 excluding staff time and overhead by the Healthcare Financial Management Association (HFMA), and the financial blow becomes even more substantial.
Fortunately, technology offers a powerful weapon against denied claims. By implementing revenue cycle management (RCM) software, physician practices can significantly reduce denials and streamline the entire revenue cycle process. Here's a look at three key ways technology can help:
1. Prevent Denials with Streamlined Insurance Eligibility Processes
The American Academy of Professional Coders (AAPC) identifies the top three reasons for denied claims:
These top reasons alone account for up to 24% of all denied claims. Thankfully, eligibility verification software tackles these issues head-on. Looking for solutions If you are looking for solutions offering real-time training on your data look no further. DataRovers Eligibility Copilot enables these features for you. Just upload your documents and get answered according to the uploaded payor documents.
2. Eliminate Errors Before Claims Go Out the Door
Claim submission is a minefield for errors. Manual processes are inherently prone to human mistakes, including coding inconsistencies, missing information, and simple typos. DataRovers Denials management software identifies these errors before claims are even submitted. The software automatically flags discrepancies, notifying billers so they can make corrections and ensure clean claims are sent out. This denial management solution also provides valuable insights into the root causes of mistakes based on reason codes. By pinpointing these problem areas, practices can implement targeted interventions to prevent future errors.
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3. Streamline Denied Claim Rework
Even with the best preventive measures, denied claims will still occasionally occur. Traditionally, practices might prioritize working only on high-value claims, neglecting smaller denials. However, these seemingly insignificant denials can collectively add up to thousands of dollars in lost revenue annually.?
Denials management software empowers practices to recoup more of this lost income by streamlining the rework process and making it easier to address all denied claims. Look for features that allow grouping denials by reason code, enabling focused resolution efforts. The ability to view the original claim side-by-side with the payer's explanation of benefits (EOB) further expedites the process. Pre-populated appeal letter templates are another valuable tool, allowing for faster claim rework and appeals.
Moving Beyond Denied Claims as an Inevitability
Viewing denied claims as an unavoidable evil is a relic of the past. By implementing the right revenue cycle management technology, physician practices can significantly reduce denials and make the rework process more efficient. Cloud-based solutions eliminate the need for expensive hardware installations, allowing practices to get up and running quickly with minimal disruption.
Data-driven Solutions for a Healthy Revenue Cycle
Consider a solution like the DataRovers solution suite. This comprehensive RCM software empowers providers to address denials and facilitate claim appeals and effortless information retrieval improving the revenue cycle, from eligibility verification to claim submission and advanced denials management. All within a single, user-friendly platform. The benefits of practices include:
Take control of your revenue cycle and watch your practice thrive. Let technology be your shield against denied claims.