Don't Make These Avoidable Mistakes With Your Denial Management Strategy

In 2015, hospitals and healthcare organizations are constantly on the move—and as a critical part of the team, you’re riding shotgun. There’s a lot of change in the air this year, from shifting reimbursement rates to ICD-10. With all of these new processes and protocols happening at once, it’s all too easy to let other areas of your organization slip, like your denial management strategy.

Mistakes

But now’s not the time to take your foot off the gas; now’s the time to double down on your efforts to ensure you’re not only keeping your revenue streams full and healthy, but helping your team provide the highest level of patient care and satisfaction too.

And when it comes to denial management, it starts by cutting out these easily avoidable mistakes:

Failure to Streamline Your Denial Management Process

Establishing an effective denial management strategy is only as complicated as you make it. There’s no magic solution to make denied claims go away, nor is there a button you can press to automate their completion. It’s all about educating your patients about their responsibilities, and providing them with the information and experience they need in order to get your organization paid. But, establishing an effective denial management strategy takes some thought on your end.

After all, insurance denials aren’t as complicated as they are tedious, and it’s easy for them to pile up if you aren’t staying on top of them. Remember, denied claims take twice as long to get approved, and the constant back and forth between your company and the insurance carrier wastes time that would be better served in other areas of your organization.

Failure To Produce An Experienced Support Team

If you’re goal is to increase your collection rates and patient satisfaction scores, hiring inexperienced patient support representatives isn’t the way to get there. Your team needs to be well versed in all aspects of the denial management process, from payer insurance to customer service experience, in order to maximize your collections rate. They need to be able to:

  • Communicate clearly with patients

  • Educate patients on their responsibilities

  • Use positive language to promote brand satisfaction

As I’ve said before, there are plenty of concerns that demand your attention in 2015, and worrying about whether or not your team is even capable of handling your denials shouldn’t be one of them. If you don’t feel like your internal team is capable of handling denials (or your internal team is too expensive to manage) you could hire an outsourced denial management solution. The best solutions are able to manage your denials and maximize your revenue streams while improving both your patient and brand satisfaction. Remember, you’re only as good as your last patient says you are.

Failure To Complete Denials In Timely Fashion

This is one of those mistakes that can drive anyone bonkers. You know how it goes… your team has a backlog of claim denials that require attention, but they’re having trouble finishing the denials in a timely fashion. No rush, you’ll get to them eventually, right? Wrong.

RunningOutOfTime

Insurance agencies can place expirations on the claim if it isn’t completed in time. In fact, many insurance agencies have aggressive expirations for this exact reason. The original denial is still owed, and now you have to worry about expirations?

Not if you’re denial management strategy is efficient.

You should focus on creating a strict timeline for denials that enter your system, and track their progress and expiration dates to make sure you aren’t losing out on revenue that’s owed to you. Shoot to have your denied claims rotating out within a week from entering your system. That way you can create a more automated process to nip expirations in the bud.

Where To Go From Here?

These mistakes are only a handful of the problems healthcare organizations face on a daily basis. But in order to get the most out of your denied claims, you need to build (or outsource) a full denial management solution—one that covers each step of the process. If you’re interested in denial management services and how VARO Healthcare fits, download our checklist below.

Determine If You Need Denial Management Services

Topics: Denial Management Strategy

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