By: Zach Simpson
- Review EOBs and determine where denials are originating and their root cause
While reviewing EOBs practices need to determine if a trend can be established that identifies the root cause for why claims are being denied. Trends can be established by asking if most denials are originating in your patient access and registration departments, or are denials occurring because of insufficient documentation, or due to billing or coding errors?
- Determine what remediation will have the greatest impact and prioritize based on your practice’s goals
As you all are aware the claim cycle is composed of three areas: front-end, mid-cycle, and back-end. Once practices determine which cycle is associated with the most denial issues they then need to determine if they need to focus on issues with a certain physician(s), or staff members, or if the issues are all stemming from a particular payor? Once you determine which area is being impacted you must determine and prioritize what efforts will generate the greatest return, meaning will all staff members benefit from a specific training, or is it a single staff member creating a link in the chain.
- Ensure that your revenue cycle technology isn’t outdated
If your practice is seeing a rise in denial rates, or if your practice is having difficulty in reducing denials it may be a warning sign that inadequate technology and services are being used to manage the revenue cycle. Practices need to evaluate the technology that they are utilizing to determine if all technology is performing as expected, or if multiple programs are used if they are communicating effectively between each program.
- Utilize advanced analytics and AI
Something that all providers need to be aware of is that payors will always have the ability to outspend providers on the technology resources that will help with their analytics. Due to the fact that payors are able to greatly outspend providers in the AI space providers are at a great disadvantage, because as payors ability to accurately detect claim issues increases, providers ability to prevent and address denials is stagnant. For providers to level the playing field, it is vital to invest in technology or experts to identify where denials are originating so root problems can be addressed and specific solutions can be generated.
- Seek advice from experts
Here at the Florida Healthcare Law Firm we have the ability to help address providers toughest revenue cycle issues while generating strategic solutions that ultimately will allow providers to remain focused on what matters most: treating the patients that come to them for excellent patient care.