10 Reasons Why Hospitals Must Automate their Denial Management Process in 2017

 Erika Regulsky Tags: , , , , RCM
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2017 is here. And so is the challenging and uncertain path of value based care. To gird with the new payment environment hospitals need to automate their denial management process. According to a recent study by HIMSS Analytics healthcare organizations are in the need of an effective and sophisticated way to handle denied claims in lockstep with their journey towards value based care.

The HIMSS Analytics study reveals that:

HIMSS anlaytics

RCM Best Practices for Group Practices and Hospitals

10 quick reasons why hospitals must stop handling denials manually

  1. The average cost of reworking a claim is $25 according to MGMA. Automating the denial management process reduces the cost of handling denials.
  2. The denial management process is fragmented. Automated denial management processes are unified and centralized.
  3. There are several teams involved in the denial management process such as the AR calling team and variance teams. An automated process streamlines cross-departmental workflows.
  4. Most denial management softwares offer exception-based workflows that enable staff to focus on high value claims.
  5. Hospitals can track high impact outliers and denial patterns consistently by automating the denial management process.
  6. All claims are appealed. But that isn’t enough reason to be laidback. A denial management software equips hospitals to measure appeal effectiveness.
  7. Working in a reactive way towards denials will not work. An automated denial management process incorporates denial avoidance strategies into the everyday workflow of hospitals.
  8. It consolidates denial intelligence in one single platform and bubbles up recurrent denials.
  9. By eliminating manual categorizing and follow-up lists a denial management software improves days receivable (DRO) rate for hospitals.
  10. An automated denial management system that can track the efficiency of follow-up resolution procedures will give hospitals an edge during contract negotiations.

Tools to automate your denial management process effectively

See how Orlando Health increased their revenue recovery by using an automated denial management process…

In a recent article for Revenue Cycle Management Insights ,Bridget Walters, the patient accounting director of Orlando Health, spoke on how automating denial management helped her organization. “We were missing a standard way to map and categorize denials to address them more consistently”, she revealed. After using an automated solution the Orlando Health healthcare organization saw a steep drop in authorization denials by $3 million dollars a month. The total revenue recovery was $7-8 million a month.

Well, it is as clear as daylight. By automating the way denials are analysed, categorized, followed-up on and resolved, hospitals and healthcare organizations can increase bottom-line benefits, contain costs and eliminate manual errors. Just the perfect way to transition to the value based environment on the right foot. And, yes, tackle the tricky revenue management hassles 2017 throws up.

Audit your revenue cycle today

Click on the Image below to Enlarge:automate denials


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I’m a multi-certified revenue cycle management professional and compliance officer with 20+ years of experience. I contribute articles to leading healthcare publications and journals. I am currently working as Senior Transition Manager, in BillingParadise headquartered at Diamond bar, California. BillingParadise offers Medical Billing Services that intersect perfectly with the EMR/Practice management system you use.BillingParadise has offices in New Jersey, New York, Florida, Georgia, Minnesota, and Texas.


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