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denial management solutions

Expert Denial Management Solutions To Practice In Your Facility

The biggest setback for any hospital or clinic is to lose revenue. This could be due to a weak RCM strategy or lack of attention to claiming reimbursement. This cycle then continues until you identify the problem and come up with a new strategy. Here denial management solutions come into play. These are the techniques that make your process efficient. 

Denials are a common issue faced by many healthcare facilities. They can’t help but cry over the lost revenue amount. So there is a roadmap you must follow in order to become aware of the reasons for your denials, control the issue, resolve the error, and resubmit the claim for revenue collection. 

To help your facility recover its revenue, here is a detailed guide on top denial management solutions that will prove valuable once implemented in your RCM.

Why Is Denial Management Important?

person counting money

When providing medical treatment to patients, your facility spends hundreds or maybe thousands of dollars to ensure their health. This includes quality care, clean medical supplies, and 24/7 beds and other emergency needs. This expense is for a single patient. Now you can imagine how much would it be when we calculate the average facility’s daily patient count which is 50-400 depending on the size of the facility. With this massive spending on patients, you would surely ask for some revenue in return.

Hospitals collect this revenue mostly in 2 ways, by directly receiving bills from the patient or by collecting reimbursement from their insurance packages. To receive the insured amount, you have to file claims in which patient medical treatment details are mentioned so that insurance payers can make the payment according to the coverage.

The importance of denial management solutions can be known with the facts that say:

  • A considerable portion of claims get denied promptly. Studies suggest anywhere from 20% to 30% of all healthcare claims submitted to insurers are rejected. 
  • Denied claims mean billions in lost revenue for the healthcare facility. A recent study estimated that oversight denials alone cost providers $262 billion annually. That money could be used to improve patient care, invest in new technologies, or expand services. This amount could also result in strengthening your financial reputation.

With that being said, you now may understand that by spending much on patients you deserve a substantial amount of revenue for your efforts and the claim is the biggest source to gather revenue. So it is essential for you to implement proper denial management to ensure you never lose your payments.

Proven Denial Management Solutions

3 peopls discussing a project

So we have informed you about the criticality of conducting this management system in your hospital. But how exactly are you going to do that? Here are top denial management solutions that if you follow all, your claims will be accepted in no time and you will receive your revenue within days after submitting. 

Predictive Analytics

The analysis is the only thing that will protect your future claims from getting rejected. Utilize advanced analytical features to identify denial patterns, note down common denial reasons, and ensure error reduction before submitting a claim. 

You can use Artificial Intelligence (AI) algorithms here to study the inconsistencies and potential denial triggers. This way you will create perfect claims without containing even the least chance to get rejected.

Automation

Install and implement automation tools to minimize manual intervention, resulting in the elimination of common errors. You can even automate repetitive tasks to reduce manual efforts. Thus you have a robot-like software that performs all the denial management tasks you might be performing, and that too within less time and least amount of inaccuracies.

Blockchain For Data Integrity And Security

Blockchain is a new discovery in the world of the internet. It ensures the safe transfer of data online. In the case of managing denials, you can share your patient’s data with the insurance company without worrying about data breaches. It also enables you to comply with healthcare regulations like HIPAA

Want to Know More Denial Management Tricks?

Telehealth Integration

Every healthcare facility these days must offer telehealth services to their patients. Most of the time they are unable to visit the hospital physically. This lack of presence in your facility can cause claim denial later on because providers ask for the appointment of the patient. It helps them ensure they visit you, undergo treatment, and are eligible for insurance coverage.

Facilitate your patients with online scheduling, video call appointments, checkups, and on-call medical consultations.

Patient Education Strategies

Another great addition to denial management solutions is to prepare educational materials to inform your patients with the claim processes. Tell them the things to avoid that could result in straightforward denials. This way the burden of the bill will only be put on patients. So make them understand the dos and don’ts of billing procedures.

Teach your patients about their financial responsibilities. It is also a good idea to offer them payment options to avoid eligibility or non-compliance issues.

Continuous Performance Monitoring

Last but not least, implement robust claim denial analytical procedures. This will help you monitor how often your claims are being rejected. Analytics also enables you to measure the effectiveness of your denial management solutions and strategies. 

Without proper monitoring, your efforts are just a waste.

Technology Tools To Boost Your Efforts

person working on computer on claim denials

Only having some denial management solutions is not enough. You must know some tools to begin with. But worry not. Where we have provided a detailed guide on preventing your claim denials, we have a list of some tools as well that you can install and use right ahead.

Automation Software: Streamlines repetitive tasks, enhancing efficiency and reducing manual effort.

  • MedBatch
  • Recondo Technology
  • Waystar

Machine Learning Algorithms: Analyzes historical data to predict denial risks and identify patterns for proactive intervention.

  • Health Catalyst
  • nThrive
  • Apixio

Real-Time Claim Status Tools: Provide instant access to claim status information to monitor progress and facilitate prompt resolution.

  • Availity
  • Change Healthcare
  • InstaMed

Electronic Health Record (EHR) Systems: EHR captures and tracks denial-related information seamlessly within existing healthcare facility softwares.

  • Epic Systems
  • Cerner Corporation
  • Allscripts

Telehealth and Remote Consultation Platforms: Facilitates virtual interactions between providers and patients, improving documentation and reducing denial risks.

  • Teladoc Health
  • Amwell
  • Doxy.me

Data Analytics Dashboards: Visualizes denial trends and key performance indicators to identify areas for improvement and optimize strategies.

  • Tableau
  • Power BI
  • Qlik

Cloud-Based Solutions: Enhances scalability, accessibility, and data security in denial management processes.

  • Salesforce Health Cloud
  • Athenahealth
  • Kareo

Mobile Applications: Enables access to denial management tools and information on the go for quicker resolution.

  • Waystar Mobile
  • Availity Mobile
  • SimpleePAY Mobile

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    Boost Your Bottom Line

    If you want to catch the revenue you might be losing due to payer rejections, put these denial management solutions into practice today. We guarantee you will see improvements in your efforts and that is equal to maximized revenue.

    So don’t waste your time here and there and educate your staff with these updated denial management strategies.

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