Improve your claim denial management

Published on: 
Medical Economics Journal, Vol. 95 No 07, Volume 95, Issue 07

Denials continue to frustrate medical practices. That’s why focusing on the 90 percent that are avoidable is important. That’s where the hidden revenue lies.

1st: Heal thyself

The first step is to remove the physician from the day-to-day denials-management process. Physicians around the world are already spending too much time behind a computer screen. A study published in the Annals of Internal Medicine found physicians spend a significant part of their day not treating patients, but instead completing other tasks. These physicians spent approximately 27 percent of their time in face-to-face clinical contact with patients, while spending up to four hours on “desk work” for every one hour treating patients. This study had a somewhat small sample size, but it’s easy to see that as contracting and billing grows more complex, physicians may spend more time with a computer and less with patients.

From the 4/10/18 issue of Medical Economics.


More: Top 8 worst administrative hassles according to physicians


Whether the billing experts are members of the practice or external experts, physicians who hand off the denials management process increase the time they can spend with patients, and can improve productivity and boost revenue by allowing experts to take control of the process.



2nd: Automate

Artificial intelligence (AI) is all over the news today, often classified as a savior to business or the end of the workplace as we know it. The truth, like anything, is somewhere in between. AI, like other technologies, is a tool that can be used to increase productivity and efficiency. For providers, AI’s older sibling, automation, can be used to decrease, or even eliminate, denials.

As a business practice, automation can be used to enhance the provider’s office staff. An automated denials management solution can increase efficiency by allowing staff to focus on other issues that require resolution. 

A well-thought-out automated denials management solution actually starts long before any claim is denied. To whittle away at the 90 percent of denials that are avoidable, the process should begin early. 

Next: Bringing it all together


3rd: Bring it together

Attacking denied claims in advance, before they happen, is the objective. This allows providers the opportunity to chip away at that 90 percent. While there are many ways to affect this number, here are three important tactics to start with:

Patient eligibility should be high on the provider checklist. Checking patient eligibility in advance ensures that patients have insurance to cover the treatment. 

The claim itself must be clean: treatment codes, which change over time, must be kept up-to-date. 

No matter how much effort is expended verifying eligibility and checking claims, some will be denied. But even this event has a positive outcome: Practices can understand and identify the common reasons for denials, which will help prevent them in the future. 

Automating this portion of the revenue cycle management process can provide exceptional value to providers as the process also influences the more than 50 percent of denied claims that are never resubmitted to payers. The best solutions examine current and retroactive denials to ensure the practice receives all the reimbursement it deserves, which helps ensures providers get on the right side of that 90 percent.