The denial denials are shooting, as are the stress levels of the income cycle leaders. In our most recently Status of the claims survey54% of respondents said that current claims technology is sufficient to address the demands of the existing income cycle in their organizations. However, that number was 77% Just two years ago.
This is because denial management has a long reactive strategy. Many organizations focus on addressing claims denials after services are provided and information is sent to payers. However, this leading approach to higher labor costs, delayed reimbursements and a greater volume of denied claims. It is time for a paradigm shift towards the prevention of claim denial, a proactive strategy that addresses possible problems before it results in denials.
To avoid claim denials, go to the defensive
Jordan Levitt, senior vice president of Experian Health, sees it as a defense.
“We use a term called” perimeter defense “: obtain patient information directly in the front, before entering the system,” says Levitt. “The denials are having because the incorrect or bad data arrive early, which costs the time and money of the health systems to fix in the back -end. The mentality is moving from the administration to prevention.”
The inherited denial management approach that is used today implies a significant manual intervention, which includes correcting errors, re -conventive claims and negations. The result is an expensive and slow process that diverts valuable resources of more strategic tasks.
The prevention of denial, on the other hand, focuses on addressing possible problems in the front of the income cycle. By ensuring that claims are precise and complete before submitting, organizations can significantly reduce volume or claims denied. This proactive approach not only accelerates cash flow, but also reduces billing personnel and reduces continence suppliers rates.
Patient’s bad data are like a virus
“There is an adage of the income cycle or referring to” Know your patient, “says Levitt.” With the philosophy of denial prevention, in registration and programming we need to know exactly who they are (for example, John Smith or Jonathan Smith?), Where they live and how to get to them, in addition to all their coverage, the order of billing – All. “
The inherent problem today, is that the first time that the data of incorrect or outdated patients is inserted into a health system, proliferates through complete System. Electronic health records are excellent for maintaining patient data together for a health system, but do not distinguish between good data and bad data. All are just data.
“Whether a patient goes to a medical office, a commercial office or residence and the information is incorrect, it is filled through an integrated system: hospitals, urgent care, laboratories,” says Levitt. “Once you leave bad data at the door, regardless of the point of origin, it is like a virus. Every time it happens and you are building the work tails and you are building cubes of contingency funds if you cannot solve it at the beginning of the process.
The fixing of poor data at the front is the key to preventing claims denials
That seems an obvious solution. However, throwing more people into the problem is not the correct answer when technology is faster, more precise and totally integrated into workflows is available.
The resolution of incorrect or missing choice, the insurance coverage, the beneficiary identifier of Medicare (MBI), the demography and the continuation of the benefits is easily notable with only a simple click. Experian health Patient access curator It is a solid solution of the income cycle designed to prevention of denial denials in the front.
It addresses the poor quality of the data with the correction of data in real time, the performance of chosen controls, the coordination of the benefits (COB), the identifier of beneficiaries of Medicare (MBI), the demography and the discovery in a single solution. With a single click, Patient access curator Ensures rapid and precise registration and programming, the significant reduction of denial volumes and billing errors, which include:
- Eligibility verification: Automatically interrogate 271 answers to indicate any secondary or tertiary coverage data.
- Coverage discovery: It works behind the scene to minimize the cost of insurance discovery and rationalize workflows, or generate additional insurance income lost by previous processes.
- MBI correction: Find and continuously correct the MBI using artificial intelligence (AI), analysis in memory and automation of robotic processes.
- Demographic updates: Automatically identifies obsolete or inaccurate data using proprietary algorithms.
- Mazorgeo analysis: Analyze each response of the payer in real time at the point of service and integrates directly into the eligibility verification process.
Benefits of prevention of claim denial
When making a successful transition to a denial prevention strategy, income cycle equipment can:
- Reduce denial volumes: When addressing problems before presenting, organizations can significantly reduce the volume of denied claims.
- Lower labor costs: Automation and real -time data correction reduce the need for manual intervention, which allows staff to focus on more added value tasks.
- Acceleration cash flow: The presentation of faster and more precise claims leads to faster reimbursements and an improved cash flow.
- Improve patient satisfaction: Precise and timely claims processing reduces the need for patient monitoring and improves the patient’s general satisfaction.
Beyond denial management: strategic change to claim denial prevention
The transition from the denial management of claim to the prevention of denial repeats a significant change in the way in which medical care organizations address the management of the income cycle. Focusing on proactive strategies and leveraging advanced technologies such as Patient access curatorOrganizations can reduce the load of denied claims, reduce costs and improve general efficiency. Adopting denial prevention is not just a strategic advantage, it is a necessity in the complex panorama of today’s health.
Watch the video to see how Patient access curator It is evolving access to the patient at light speed, using the AI and automatic learning.
Get more information about Patient access curator And contact us to see if you qualify for a free denial analysis.
