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Decrease denied claims

Patient Access Weekly Advisor, April 23, 2008

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P>Before approaching a managed care company to address a technical denial or a clinical denial, ensure that you have addressed process issues inside your hospital. Having done so will help you minimize denials that are the hospital’s fault and avoid the inevitable payer accusation that your hospital cannot get its own house in order.

You can significantly reduce these administrative denials by ensuring that staff follow certain processes and procedures to get it right from the beginning:

1. Establish a starting point. Ensure that your staff are registering and getting precertification, billing correctly, and monitoring payments appropriately.
2. Think timelines. Make sure that you have a process to notify the payer in a timely fashion on day one of the admission. Staff should confirm eligibility and double check data integrity to avoid administrative denials.

As managed care contracts get complex, ensuring technical contract compliance has become a greater challenge. Complex rule-based engines—such as that offered by Concuity—are a good place to start if you are evaluating that piece of the puzzle. Many other organizations exist to quickly address front-end reasons for technical denials.

Note: This tip, by Joseph Zebrowitz, MD, and Scott Scheer, DO, of Executive Health Resources, was featured in HCPro’s Revenue Cycle Management: A Best Practices Toolkit. To learn more about this book, click here.

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