Tackling Your Most Pressing Pain Points on Denials

Here at Nemadji, we understand that being a revenue cycle leader sometimes comes with its share of headaches—which are often triggered by denials. Here are a few of the most persistent problems that can be addressed with the right team, tools, and leadership.

A bumpy pre-registration process. One of the leading causes of denials is failing to collect the patient’s eligibility, benefits, and authorizations before the scheduled service. Fortunately, you can put processes in place so your staff collects this important information upfront. Your back-end team can even help your front-end team understand what patient and insurance information is critical to capture so services are covered by the plan. Eligibility detection tools also can fill the gaps at different steps in the revenue cycle to identify missed accounts with reimbursement potential—and prevent revenue from falling through the cracks.

Missing or invalid claim data. Insufficient information on a claim, such as a missing date of birth or social security number, is another common cause of denials. But it doesn’t have to be—you can implement quality control and workflow procedures to ensure your claims are complete and will not get bounced back to your team. Start with a process review to determine areas for improvement, and then work with your managers to resolve problems that affect your team’s efficiency.

Chronic coding issues. Entering the wrong code is a common cause for denials. In other cases, the coding needs to be more specific to avoid denials. Your coding team should strive to code at the highest level to avoid these errors. Proper coding practices also can help prevent denials due to insufficient documentation. To prevent issues from occurring in the first place, your leadership can empower your clinical documentation improvement team to collaborate with physicians to get the most complete documentation in the medical record. Sometimes, this requires a cultural shift, so securing leadership support is critical.

A pattern of untimely filing. Today’s revenue cycle teams have a lot of demands, and they are not always able to file a claim within the insurer’s time window—especially if they have made several attempts to rework and resubmit a tricky claim. Outsourcing the denials management process can help reduce backlogs and ease the burden on your team so you can meet your performance goals. We helped one client overturn four out of five timely filing denials, which helped boost their revenue and ease stress on their staff. Choose a partner who understands your goals and whose incentives are aligned to those goals.

Failing to properly track and analyze denials. Today’s technology tools can help revenue cycle teams monitor where they are having the most problems with denials—and identify opportunities to prevent denials from happening in the first place. Technology also can uncover issues with individual payers so your team can collaborate with plans on finding solutions to make the process more efficient. Beyond looking at individual payers, it also is smart to review data during specific time frames to help you identify trends.

By addressing these costly trouble areas, you can lower your team’s barriers to better performance. Pick a process that needs improvement and get started today. And remember: Sometimes, the most important strategy for reducing denials is to be persistent. It’s not uncommon for our specialists to work for years to resolve complex claims that have been denied. Persistence does pay off!

Further Reading

August 17, 2023

Nemadji’s 4th Annual PAM Week Recognition Program

In honor of National Patient Account Management (PAM) Week, Nemadji is taking nominations to recognize outstanding patient account management staff. According to AAHAM, PAM Week […]

Read more
medical bill with credit cards

April 26, 2023

Interpreting Medical Bills In Real Life

Medical billing is overwhelming and complex for patients. According to a recent public opinion survey, 72% of consumers are confused by their medical bills. The […]

Read more

April 3, 2023

The End of the Public Health Emergency

The expiration date of the public health emergency is currently set for May 11, the senate recently passed a resolution that may result in an […]

Read more