4 Tips on Claims Denial Management

1. Correct all denials within five days. If a bill is returned to a practice because it was submitted incorrectly to an insurance company, the bill should be corrected and resubmitted to the payer within five days.  The way to do this is to create a strong workflow process.  Part of the process is implementing a common communication platform across an entire system to help ensure the denial and the communication that relates to the denial are being adequately tracked.

Many health insurers set time limits for practices to appeal a denial, and hospitals should always track the appeal time limit. This can be done by using an aging report that shows how long a claim has existed.

2. Don’t lose track of claims. A claim that gets lost in the system is really lost money. This typically occurs when claims are put into the system and no one knows it is there, or when there is not enough staff to cover all of the claims. To help address this issue you should use a tool that requires transparency to let practices to see why claims are being lost in the system. By allowing a practice to see what stage a claim is being lost at and the cause for any delays, a transparency tool can provide hospitals the information they need to improve their claims denial processes.

3. Define the problem. Practices should look at their denials every month. They need to determine the net loss by payer, the net loss by patient type and the net loss by clinical area to really understand denials.

Think of everything as an opportunity. Tracking claims allows practices to see the root causes of denials and to focus on getting the right information to the insurer the first time. Front-end avoidance is very important in denial management.

4. Document successes and failures. A practices financial performance is based on working denials. By documenting what processes are working and keeping track of lost claims or other denial management failures, it’s going to improve the process and practices  are going to be more efficient. In the realm of claims denial management making even small improvements will help.