Dealing with Denials: Another Look at Some Great Advice

Let’s face it: next to the health of your patients, there are few things as important as the financial health of your organization.

We’ve been talking about denials and their potentially devastating revenue cycle effects for some time. We know we’re not the only ones, but we’re happy to report that many of our clients have reduced denials and improved financial performance by taking our advice.

With that in mind, we thought we’d share important details from a previous blog on the subject. Those details center around the six tips we offered back in 2014 for improving efficiencies with regard to claim submissions and rework due to denials. We think you’ll agree they’re still as pertinent today as they were then.

Monitor Pull a report for all suspended claims, or pick several at random and call the insurance company to ensure that they have been received.

Use denial codes Never just automatically write claims off at the first rejection. The employee keying payments should post the type of denial (non-covered service, etc.), mark it on the explanation of benefits (EOB) and give it to someone to re-work.

Understand the appeal process If a claim is denied again after it has been re-worked and corrected, then consider appealing it. Work from a customizable appeals letter template.

Know the deadlines Don’t miss important filing deadlines as you re-work claims. Do careful tracking and assign staff accountability as appropriate.

Keep track of self-suspended claims Don’t forget about claims that the practice has suspended because of inaccurate or missing information or other details. Assign staff accountability to assure self-suspended claims are worked, resolved and submitted as quickly as possible.

Stop playing the blame game Identify problems and find ways to fix them. When the same mistakes occur over and over again, it is often due to a faulty a process or procedure, insufficient monitoring or a lack of training. 

If you're interested in real results on an insurance project, check out the case study below. You can be sure we followed our own advice (above) when it came to working claims for Northeast Georgia Health System. Click below for the full story.

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About Kent Smith

Kent Smith

Kent leads MediRevv’s new business sales initiatives and marketing and account management programs. He has built, from the ground up, a cohesive team of healthcare sales and marketing professionals who understand the critical aspects of any engagement: exceeding the expectations of and creating value for our clients; building enduring, mutually beneficial partnerships; and maintaining transparency and a high level of trust in our execution.

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