According to an analysis report of data released by CMS – approximately 18% of in-network claims were denied on average during the reporting period. The pressure to reduce claim denials is at a peak in the healthcare industry. Every healthcare organization wants to look at its claims process with granularity to reduce the rate of denials.

Achieving a higher rate of Clean Claims (claims approved in the first submission) helps set precedence for claim approval for your healthcare organization. Implementing the right strategy with effective vendor and outsourced service partners can help you improve your Clean Claims rate. At Red Road, we have a proven system to significantly raise the Claims Approval Rate or Affirmation Rate. This article discusses process improvements for better denials management.

Track Your Claims Journey: Every claim submitted is monitored regularly to ensure its accuracy and timeliness. Real-time tracking of claims through an efficient system is important in order to know the current status of the claim. When denied, your team can then address the issues with the claim and resubmit it within the set time frame. Thorough Claims Review Process To Identify Common Causes For Denials: Dedicated resources allocated to finding the most common causes for denials for your healthcare organization could set up a review checklist to verify before claims submission. Providers can then pinpoint the areas of billing processes that lead to these common causes and rectify them at their point of origin.

Review and Update Policies and Procedures: Regularly review and update policies and procedures to ensure that they are aligned with payor requirements and industry best practices.

Provide Adequate Training: Ensure that your team receives adequate training on medical coding and billing practices to minimize errors or work with an extended team of expert medical billing and coding services.

Utilize Technology: Utilize technology such as automated claim scrubbers, electronic health records, and billing software to help reduce errors and streamline the billing process.

Monitor Performance Metrics: Establish performance metrics to track denials and appeals, including denial rates, days in accounts receivable, and recovery rates.

Develop a Denials Management Plan: Develop a comprehensive denials management plan that outlines processes for handling denials and appeals, including tracking and reporting denials and developing corrective action plans.

Continuously Improve: Continuously monitor and improve the denials management process, using data and feedback to identify areas for improvement and implement changes.

About Red Road

As a high performing extended team for your healthcare organization, Red Road provides expert clinical back-end services to improve your business efficiency and to grow your profitability. We are committed to delivering high-quality, truly responsive solutions in a cost-effective manner.

Whether it's home health medical coding services, clinical compliance reviews in the USA, or revenue cycle management, you get the highest standards of service at significant cost savings for your organization, eliminating the unnecessary and costly barriers (middle-men) to working directly with your clinical back office support solutions provider.

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