Don’t Just Manage Denied Claims. Prevent Them.
How are you managing your denials today? Do you know where they're coming from? Do you have workflows in place to bring accounts to resolution? 1/3 of hospitals report an alarming denial rate of 10% or greater of all their claims, costing up to 2% of their net patient revenue. How do you compare?
Medical necessity, prior authorization, and registration errors are the leading causes of denials. While the majority of these are preventable, and up to 2/3 are recoverable, only 33% are appealed, often because of lack of skillset and resources. Providers need a robust denials management program to stop the leakage and a strategy to prevent them in the first place.
Our Denial Management program will:
- Identify root cause of denials.
- Develop best practice operational processes to avoid denials.
- Reduce the volume of denials and write-offs.
- Improve AR days.
- Improve first pass pay rates.
- Formulate a winning appeal process.
By the Numbers
Southwestern Health System Client Results
recovered, $17M ahead of cash goal
clearance of backlogged accounts from active work queues
“Outsourcing was absolutely the right call, and I would recommend it to other organizations that have similar problems, if nothing more than to help identify what the root causes of the denials are to avoid them going forward.”
VP Revenue Cycle
Acute care facility leverages expert resources to successfully appeal clinical denials. Case Study Acute care facility leverages expert resources to successfully appeal clinical denials. A 200-bed, $509M NPR client lacked resources able to review and resolve their large volume of denials, nor did they possess the skill set to determine plausibility of certain clinical appeals.…Read More >
Safety net system transforms denial backlog into $20M+ gain. Case Study Safety net system transforms denial backlog into $20M+ gain. This 800-bed, $532M NPR safety net system struggled with retaining the resources needed to address an immense denial backlog and lacked visibility into their root causes. This threatened cash collections and financial viability of the…Read More >
Denials: An Ounce of Prevention is Worth a Pound of Revenue The old saying, “An ounce of prevention is worth a pound of cure,” rings especially true when it comes to health care claim denials. To circumvent costly rework, which typically occurs at the back of the health care revenue cycle, today’s savvy health care provider…Read More >
The Mid Revenue Cycle: Key to Reducing Claim Denials Are you experiencing documentation and coding errors? Do you suspect you may be under or over charging? If so, your denied claims rate may be robbing your organization of cash. Incorrect or incomplete documentation and coding in the middle of the revenue cycle result in more…Read More >