Turning Denials into Dollars: Optimizing Revenue Recovery from Denied Claims

1
(No Transcript)
2
Turning Denials into Dollars Optimizing Revenue
Recovery from Denied Claims

• The healthcare industry operates on a delicate
  financial balance, where providers rely on a
  steady stream of revenue to deliver quality care
  to patients. A significant challenge within this
  complex ecosystem is the denial of insurance
  claims. Denied claims not only disrupt the
  revenue cycle but also demand additional
  resources and time to rectify. To maintain
  financial stability, healthcare organizations
  must become proficient at turning denials into
  dollars by optimizing revenue recovery from
  denied claims.
• Key Strategies for Revenue Recovery
• To optimize revenue recovery from denied claims,
  healthcare organizations must implement a
  combination of proactive and reactive strategies.
  Following are some key strategies for revenue
  recovery from denied claims
• Real-Time Eligibility Verification Utilize
  real-time eligibility verification tools to
  confirm patient insurance coverage and benefits
  before providing services. This helps identify
  potential issues upfront, reducing the likelihood
  of denials related to eligibility.
• Robust Claims Scrubbing Implement a claims
  scrubbing process that thoroughly reviews claims
  before submission. This process should identify
  and rectify common errors, such
  as coding discrepancies and missing information,
  before claims are sent to payers.

3
Turning Denials into Dollars Optimizing Revenue
Recovery from Denied Claims

• Clear Documentation Encourage providers to
  maintain comprehensive and accurate
  documentation. Clear and detailed clinical notes
  can be invaluable when appealing denied claims,
  providing evidence of medical necessity and the
  appropriateness of services rendered.
• Denial Analytics Leverage data analytics to
  identify patterns and trends in denials. By
  understanding the root causes of denials,
  organizations can implement targeted process
  improvements and reduce future occurrences.
• Prompt Follow-Up Establish a robust denial
  management workflow that includes prompt
  follow-up on denied claims. The sooner denials
  are addressed, the higher the likelihood of
  successful recovery.
• Effective Appeals Develop a structured appeals
  process that includes clear and compelling
  documentation to support your case. Appeals
  should be submitted within payer-specific
  timeframes to maximize the chances of overturning
  denials.
• Comprehensive Training and Education The
  foundation of effective revenue recovery starts
  with a well-trained and informed staff. Ensure
  that your billing and coding teams are up-to-date
  on the latest regulations, coding guidelines, and
  payer policies. Ongoing education is essential to
  reduce errors that lead to denials.
• Collaborate with Payers Establish open lines of
  communication with payers. Regular discussions
  with payer representatives can help resolve
  issues more quickly and lead to improved claims
  processing.

4
Turning Denials into Dollars Optimizing Revenue
Recovery from Denied Claims

• Measuring Recovered Revenue
• To gauge the effectiveness of revenue recovery
  efforts, healthcare organizations should track
  key performance indicators (KPIs). These may
  include
• Denial Rate Monitor the percentage of claims
  denied by payers to assess the overall health of
  your revenue cycle.
• Days in Accounts Receivable (AR) Measure the
  average number of days it takes to collect
  payment after a claim is submitted. A higher AR
  indicates inefficiencies in revenue recovery.
• Appeal Success Rate Calculate the percentage of
  denied claims that are successfully appealed and
  paid.
• Clean Claim Rate Track the percentage of claims
  that are submitted error-free on the first
  attempt.
• Optimizing revenue recovery from denied claims is
  a critical aspect of financial stability for
  healthcare organizations. By implementing a
  combination of proactive strategies to prevent
  denials and reactive strategies to address them
  when they occur, providers can turn denials into
  dollars. This not only ensures a healthier bottom
  line but also supports the delivery of
  high-quality care and improves the overall
  patient experience. As the healthcare landscape
  continues to evolve, organizations that excel in
  revenue recovery will be better equipped to
  navigate the financial challenges ahead.

5
Turning Denials into Dollars Optimizing Revenue
Recovery from Denied Claims
If you are looking for a medical billing company
that can help you reduce claims denials and
improve your financial performance, Medical
Billers and Coders (MBC) is the right choice for
you. Contact us today at info_at_medicalbillersandcod
ers.com / 888-357-3226 for a free consultation.