According to a study by HIMSS Analytics on revenue cycle management, 73% of respondents said that coping with denials is the biggest challenge for their healthcare operations, and it’s for good reason.
Denials are dangerous for you and your patients. When your patients are denied claims, they might not be able to afford the care they need, or they may get angry at your healthcare system and go elsewhere. There’s also an increased risk that you will get paid late or not at all for the care you gave. In order to overcome denial issues, some healthcare systems are using in-depth analytics and automation in the coding and billing process.
Some healthcare systems are creating electronic dashboards to help them avoid denials. Employees pull data from billing systems to create dashboards that display data points of patient balances. When organizations use multiple, disparate data systems, dashboards that can show all data are crucial to recognizing and fixing problems in a timely manner.
Other healthcare systems have automated the coding and billing process in order to avoid denials wherever possible. Sharp HealthCare in San Diego programs the claim rules for each patient into their revenue cycle software so that the software alerts them about potential problems. For instance, when an identification number is entered incorrectly or when information is missing, their software highlights the issue. Then, staff can fix the problem before they submit the claim, so they are less likely to be denied.
Whether you create dashboards, build software, or work toward other denial-prevention solutions, the root of the issue often lies in messy data. When data is incongruent or stuck in silos, it’s difficult to solve payment issues quickly. Get control of your data first, then it will be easier to delve further into denial-prevention strategies.