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Denial Health Check

Six Ways to Find Dollars and Cents

“People don’t like to talk about dollars and cents, but the dollars are what allow us to keep the hospital running. The dollars are what allow us to maintain patient care.” —Brian Crawford, Chief Administrative Officer at Willis-Knighton Health System in Shreveport, Louisiana

Frankel, Todd and Tony Romm. “Historic financial decline hits doctors, dentists and hospitals—despite covid-19—threatening overall economy.” washingtonpost.com, 4 May 2020. Web. 10 May 2020.

There is no question that providing excellent patient care is paramount. Quality patient care means well trained personnel, proper instruments, medications and technologies—to name a few.

While the primary function of a hospital is not to make money—instead, to focus on serving patients and communities—dollars and cents are still required to provide these services.

Most hospitals were operating on thin margins before Coronavirus struck. Those margins have been completely eroded over the past few months—making it more evident than ever that every dollar is crucial.

Here are six ways hospitals can find extra dollars and cents:

Don’t Ignore Small Balances

If hospital staff find themselves with reduced work capacity due to reduced volumes, they can focus on reviewing denied accounts that fall under a charge threshold and wouldn’t normally be worked.

These denials may be easier to overturn and may also lead to process improvement discoveries if a common error or issue is identified.

Underpayments

Review accounts for underpayments to ensure the amount paid was the appropriate contractual amount.

Registration

Review registration to ensure that insurance is being entered correctly.

For example, if the patient presents with a United Healthcare commercial plan, ensure they are being registered under United Healthcare Commercial and not United Healthcare Medicare Advantage.

Incorrect registration can cause important steps to be missed that will cause a claim to deny. It can also cause the estimated reimbursement tools within the system to calculate projected revenue figures incorrectly and may delay payments if claims are being submitted to the wrong payer.

Examine Your Revenue Cycle

Examine all areas of your revenue cycle to ensure that you are operating in the most efficient way possible—from pre-registration to patient collections—if not, implement efficiencies where opportunities are identified.

Charge Capture & Coding

Ensure that any and all individual charges are captured from clinical staff timely, that your charge master is up to date and that charges are bundled or un-bundled accurately and appropriately—ensuring that all charges are supported by detailed clinical documentation in the medical record. With these two pieces in place, coding will see maximum accuracy and allow timely claims to get out the door as soon as possible.

Discharge Disposition & DRG Review

Confirm the discharge disposition was correct and the patient was actually transferred to another facility to ensure that appropriate reimbursement is received.

Correct any claims that were billed with a transfer discharge status that didn’t actually receive the planned discharge care.


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