Don't be in Denial
The Challenge:
Over the years, insurers have expanded and refined their "medical policy" provisions to produce a billing nightmare for providers. Without doubt, claim denials account for not only huge delays in cash flow, but at some hospitals equate to more lost revenue than self-pay bad debts and free care. To complicate matters, these issues affect many operations from registration to coding and records, to actual physician practice. While healthcare managers easily recognize the negative impact of denied payments, attempting to solve the problem can seem overwhelming. Moreover, until recently, there was a lack of uniformity among payors for reporting back denial reasons.
The Solution:
Now that HIPAA has implemented a universal code set for reporting denied transactions, hospitals can implement automated processes to capture this vital information. While a good start, simply having denial information is only the foundation of the solution. You need much, much more.
The Harvest® Contract Management System contains denial management tools and reports that not only help you recover denied payments but also help you determine the root causes of the denials. To meet the challenge of this delayed or lost revenue, we provide a dual approach toward solving the denial problem:
- Retrospective: A specialized claim list tool that identifies denied claims and services for appropriate corrective action and re-billing
- Prospective: Evaluating, categorizing and analyzing denied payment information to prevent future denials
These tools and reports will enable you to answer critical questions, such as:
- How many denied payments (full claim denials and service-level denials) do I have? For which payors?
- How much are these denials costing my organization in lost revenue?
- What are the most prevalent reasons for the denied payments?
- Which departments or individuals in my organization will be most instrumental in eliminating future denials?
Report samples are provided separately.
