7 Useful Tips to Improve Healthcare Claims Denial Management

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Claims Denial Management Tips

Most healthcare organizations lose 6 to 8 percent of their total revenue due to payment denials. A loss of this magnitude cannot be ignored by healthcare providers as these payment denials directly impact the revenue sources. Managing payment denials well is the key to improve your revenue and win over your customer’s loyalty.

An esteemed advisory board states that 90 percent of all claim denials are easily preventable. However, they still occur frequently.

Claims Denial Cost

Source: Businesswire

If you’re struggling with denial management strategies, our list will surely be of help to you.

Here are 7 Ways to Proactively Reduce Claims Denial in Healthcare

1. Understand Why Claims were Denied

Being aware of why your patient’s claims were denied is a critical first step. This awareness helps you to create a streamlined process that maximizes your revenue and help in avoiding pitfalls of claim denials. Your patients may not be fully aware of how the denial system works. In such cases, you also need to educate them about the process and why the insurance claim was denied. Helping your patients through the insurance claim process ensures a strong long-lasting relationship with them. This timely help provided to your patients goes a long way in contributing to your organization’s success. So, understand the reasons for claims denial and clarify them to your patients to ensure smooth functioning of hospital duties.

2. Streamline the Denial Management Process

Are you manually fixing your faulty claims? We admit it’s an effective short-term solution. However, looking at the bigger picture, you might want to consider a streamlined process. An effective procedure helps you reduce such issues in the future and provides a long-term solution. Losing track of denied claims and having incomplete records threaten your revenue and credibility. Using an organized system to track and manage denied claims to relieve your staff’s workload. Newer tools available in the market help your team handle and monitor denials efficiently. So, keep an overall perspective in mind when fixing recurring issues.

Claims Denial Management Solution

Source: Businesswire

3. Process Claims in a Week

Did you know that 65 percent of denied claims are never filed again?. Having a proactive claims management team is critical to avoid piling these issues. Your staff should be trained to handle claims well and re-submit any appeals (when requested). Creating a robust workflow to address the claims denial processes assists in founding a strong denial strategy. As soon as you receive a denial from an insurance company, your team should spring in action to process the claim within a week. A hands-on claims team ensures you get paid as soon as possible. If there are some common recurring errors, consider improving your claims filing strategy to address those issues.

4. Implement a Claims Denial Log

You can maintain all important data using a claims denial log. An electronic version of the log is an even better choice as it ensures access to relevant information across the organization. You can archive conversation and documentation with several insurance providers to analyze and improvise your claim denials. In addition to that, you’ll also be able to record the service dates, the demanded amount, the distinct claim numbers, and denied medical codes for easy access in the later stages. Implementing a claim log helps you assess past filing mistakes and improvise for a better coding and billing system. Additionally, using electronic payments saves you 1 minute per transaction. So, record your interactions with the insurance providers to process claims well.

5. Identify Common Healthcare Claims Denial Trends

Like all industries, the healthcare industry evolves at an exponential rate. Trends in the claims denial sector keep upgrading to keep up with the transforming healthcare industry. Recognizing different common denial types establishes an effective denial management procedure. Analyzing these trends gives you a deeper insight into the major issues plaguing your claims denial management team. Subsequently, your software upgrades addressing these issues save you money consistently. So, upgrade your knowledge in these trends to have a processing edge over your competitors and save a lot of money.

6. Outsource your Denial Management Process

Do you desire a dedicated team to process your claim denials? Consider outsourcing your denial management problems to a capable team. If you outsource well, you can save money and effort and still get efficient claims processing. Expert denial management providers train specialized teams to handle all the complications of the insurance system for you. You’ll be able to concentrate on your core competency by delegating these tasks to an efficient company. So, save time, effort, and money by outsourcing your major denial management issues to top firms.

7. Introduce Incentive Programs

The majority of claim filing errors can be fixed by trained and motivated staff. If you’re concerned about the rising software costs, consider incentivizing your staff to reduce your denials. Offer your staff bonuses or time-offs to promote healthy competition that leads to fruitful results. You’ll notice a significant reduction in denials when you use these tactics. This technique is truly the most cost-effective and efficient solution to your denial management issues. Also, share valuable information about the trends in the denial management process to help them contribute well to your claim filing processes. So, reward your employees when they do good work to bring you good results.

Conclusion

We are sure you know how to handle several healthcare claims denial management issues well now. So, save 6 to 8 percent of your revenue from these issues using our helpful tips. Focus on incentivizing and training your staff to reduce denials and motivate your team. You could also develop a strong and flexible process to deal with such issues competently. So, don’t be the team that slacks and doesn’t re-submit claims. Lead a proactive and informed team to retain your revenue.

Last Updated on August 20, 2020

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