Denial Management is Key to Profitability

July 15th, 2019 - Wyn Staheli, Director of Research
Categories:   CPT® Coding   HCPCS Coding   Compliance   Denials & Denial Management  
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A recent article by Modern Medicine cited a report by Becker’s Hospital Review which stated that it costs approximately $118 per claim to resolve a claim denial. Granted, these were hospital claims, but the process is essentially the same for outpatient services. In fact, you could say it is more costly for a smaller organization because they expend more resources for a lower return on the investment of employee time. The bottom line is that every organization should take denial management seriously!

According to the article, the number one cause of denials is eligibility. This is an easily remedied problem. Implement policies and procedures which ensure that the patient’s eligibility is established and verified BEFORE the patient is seen. This brings up another problem practices frequently face: not properly informing the patient of their financial responsibility. Once eligibility has been established, you can ensure that the proper forms (e.g., ABN for Medicare) are signed and that copays are collected immediately.

Other top claim denial problems are:

Implementing good policies and procedures that address the above list of problems can help reduce the number of claim denials that your organization faces. Not only is it good practice management, it can save you considerable time and money in the long run.

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