An effective way of reducing the number of claims denied is by improving the clean claims rate of the hospital. That means ensuring claim accuracy when the claims are initially submitted. However, there are instances where, regardless of a hospital’s diligence, the claim may be denied. What steps can a hospital take? The following are three different ways to consider as a way of turning things around boosting those rates.
Determine the primary cause. Let’s use an example of a hospital with a denial rate hovering around forty percent. It could be that the hospital’s access management staff is not terming the inactive insurance in the correct way. By addressing the root cause, it’s easier to take action, in this case training the staff on how to correctly term the insurance and how to go about properly collecting co-pays at the point of service.
Upgrade the process of patient access processes. Generally speaking, revenue cycle management has consisted of the front-end and back-end, with the latter typically concentrating on claims. However, it is vital that the front end ensures it is fully cognizant of the data being entered during the registration phase. This approach may result in cost reductions and improved outcomes.
Have a specific claim denial management team. It’s not uncommon for a hospital to have a claims denial team that has also been tasked with other responsibilities beyond appeals. These individuals should be thoroughly trained for the specific purpose of claims denials so hospitals can reap the benefits.