Hayes' Healthcare Blog

8 Tips to Help Understand and Avoid Denials

Posted by Susan Eilman on March 29, 2018 at 9:00 AM

Are you drowning in claim denials and rejections?  Are your denial rates high? It is inevitable for healthcare organizations to experience denials in today’s complex billing arena. Industry standards for denial rates are between 5-10 percent.  If your denial rate is above 10 percent, then "Houston you have a problem!” It is time to build a strategy to reduce your denial rate.

Claims denial avoidance processes should be proactive but in most healthcare organizations, they are more reactive. It is important to be proactive from a revenue integrity perspective at the front-end, and accurately collect and report patient and insurance information before or at the point-of-service. There are ways to be proactive from the billing side as well.

As you develop your action plan, it’s important to define your terms. You and your staff need to understand the difference between a claim rejection and a claim denial.

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Topics: reduce denials, claims denials, denial management, Revenue Cycle Health

Building a Denial Management System? Here’s Where to Start

Posted by Sou Chon Young on August 30, 2017 at 9:00 AM

As healthcare costs grow, reimbursement continues to decrease, and margins for providers get smaller, we see the room for error getting smaller as well.  To combat this there has been an increase in mergers and acquisitions (M&A)[1].  As the number of mergers and acquisitions increases, one result is system conversion.  Instead of disparate systems, the newly formed organizations either move to one new system or they consolidate their systems to make their processes more efficient. As more organizations implement new revenue cycle systems, they are faced with many challenges but also many opportunities – one of which is the opportunity to implement a denial management system.

A strong denial management system will help you not only identify issues with your revenue cycle and help you avoid leaving money on the table, but it will also give you the information you need to optimize it.  Below is a quick summary on how to set up a denial management system.

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Topics: A/R management, denial management

Managing Denials in a Valued-Based Reimbursement World

Posted by Revenue Cycle Transformation Team on March 8, 2017 at 9:00 AM

Claims denials continue to be a thorn in the side of most healthcare organizations. The transition from manual to electronic documentation and billing has helped but denial rates still consume an average of nearly three percent of an organization’s net revenue annually. In recent years, denials have grown to encompass 15-20 percent of the billing value of total claims. That can mean a $6 million hit for a 200-bed hospital to over $260 million for an 1100 bed facility.[1]

And things don’t figure to get any easier. The switch from fee-for-service to value-based care will complicate billing even further despite new technology solutions. Value-based payments are complex and will undoubtedly lead to more denial issues.

Reducing revenue leakage due to denials is usually at the top of every organization’s focus list. Here are three things you can do to better manage your claims process and minimize denials.

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Topics: denial management, revenue cycle management

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