Overview
As revenue cycle leaders face increasingly complex financial complexities, preventing healthcare claim denials has become a top priority. The State of Claims 2022 report by Experian Health reveals that 30% of respondents experience claim denials 10-15% of the time, while 42% have seen the rate of denials increase year over year. These often-avoidable denials result in significant waste, costing providers hundreds of billions of dollars in lost profits annually.
In this blog, we will explore the effective denial management strategies, and how right denial management solution can play a pivotal role in improving healthcare denial management.
What is the best way to track and manage claim denials? Key Denial Prevention Strategies
Here are some simpler denial prevention strategies:
Moving from Paper to Digital—Step into Healthcare Innovation
Most healthcare providers use a mix of manual and digital tools to handle claims and denials. Switching to digital systems can save time, reduce errors, and make everything run smoother. However, some providers worry about the cost, making sure different systems work together (data interoperability), and training their staff on new tools. The key is to find a healthcare denial management software that fits your specific needs.
Implementing Denial Management Solutions —Take Control
Always choose a healthcare denial management software that eliminates manual work and lets providers focus on what matters most in the claims process. Well, DataRovers Healthcare denial management solution is a multi-tasker that enables predictive denials management by implementing healthcare denials predictive models.
This denial prevention and recovery solution creates smart queues to prioritize potential claims, like the type of denial and how much money is involved. It also analyzes data to find the root cause of denials so you can prevent them from happening again. This system can work alone or be connected with
appeal software, which gives claim denials in one place.
Staff Training on Denial Management Strategies—Knowledge is Power
A recent report showed that nearly half of the healthcare providers said a lack of staff training in healthcare denial prevention strategies. Training your staff on how to manage and prevent claim denials is a smart investment. Hospitals should provide ongoing training on the details of claims processing, before and after submitting claims. Staff should also be familiar with the latest tools and rules for submitting claims to get paid.
Engaging Patients—Partners in Getting Paid
While patients typically don’t submit claims themselves, they are equally involved in the process. Patients can be empowered to help at every step, from submitting claims to getting approval and paying any copays or deductibles. Hospitals can offer patients an easy-to-use online platform to register, update their insurance information, and communicate with staff.
Working with Payers—A Team Effort
The well providers and payers work together affects the smooth claims process. Providers need to collaborate with payers, especially since insurance rules change often. By working together, providers can stay up to date on payer requirements and resolve denials faster. Eventually making the whole system more efficient for everyone. In the current era, the best way to stay compliant with payer policies is to use policy software or healthcare policy chatbots. Using AI Chatbots can keep you updated with ongoing payer policy changes and help you work with payers seamlessly.
Hospitals Losing Millions Due to Denied Claims? AI-Powered Solution Can Be Saviour!
Millions are being lost by hospitals due to claim denials – a staggering 35% of hospitals report losses exceeding $50 million! This highlights a crucial need for innovation in implementing denial management solutions management and denial prevention strategies. When claims are denied, it not only means lost revenue but also leads to extra costs due to rework. Thus, adding more strain on already stretched resources.
DataRovers steps in with Denials 360, a revolutionary AI-powered solution designed to combat these challenges. This two-pronged approach leverages ML and artificial intelligence to optimize denial management for healthcare providers.
Here’s how Denials 360 empowers healthcare providers to for fastest reimbursements:
Predictive Denial Prevention
Denials 360 acts as an intelligent shield, it uses analyzing historical data to identify potential denials based on hidden payer rules. This foresight allows providers to take corrective actions before resubmission of claims. Hence, significantly reducing unnecessary denials.
Prioritized Denial Submission
Denials 360 doesn’t stop there. It also tackles existing denials with intelligent algorithms. These algorithms categorize healthcare denials based on their potential financial impact, allowing you to prioritize the most fruitful resubmissions. This eliminates guesswork, frees up valuable staff time, and ensures you focus on denials with the greatest chance of boosting your bottom line.
Implementing denial prevention strategies and Denials 360 streamlines the entire healthcare denial management process, prioritizing what truly matters – getting you paid for the services you deliver.
