Effective Management of Claim Denials Increases Revenue, Improves Patient Satisfaction

Managing claim denials is a critical component of effective revenue cycle management, and careful attention to the process can help ambulatory surgery center (ASC) leadership increase revenue and collections rates while improving patient satisfaction.

The experts at Regent Revenue Cycle Management (Regent RCM) understand the importance of maintaining an organized system to keep track of claim denials, so they don’t accumulate unnoticed over time. As one strategy, many providers use technological tools to manage denials and track claims that still need attention to maximize collections revenue.

“The process of managing denials starts with a thorough understanding of when and why patient claims are denied,” says Erin Petrie, Regent RCM’s Director of Revenue Cycle Management. “Many times, patients don’t understand how the claims process works, and need help solving issues that arise. Being organized and ready to provide support goes a long way toward heading off potential claims denial problems, and helps boost patient satisfaction as well.”

Petrie offers three suggestions for providers seeking to improve claim denial management:

Streamline Workflow:  Every denied claim should be addressed within a week of receiving the denial from an insurance company. Efficient tracking of claims as they enter and exit your system eliminates the risk that a correction can’t be made because the claim has passed the insurance company’s time limit for appeal.

Keep Score: When appealing denied claims, it helps to know what has worked in the past, and what processes need more support. Collecting analytics regarding the reasons claims are denied, the time spent on denials, and lost or expired opportunities can improve efficiency.

Watch for Patterns: Finally, knowing which types of denials your organization sees most – whether they stem from errors like misspelled names, procedural missteps, or missing information – can help guide a more effective denial management process. Understanding your organization’s denial patterns can guide the steps needed to prevent predictable issues.

While investment in these activities pays off, given other priorities, the staff required to manage claim denials well isn’t always available within an ASC. In those cases, Petrie recommends providers consider outsourcing the process to an experienced revenue cycle management firm.

“One benefit of outsourcing the process comes from the experience and efficiency of trained specialists, who are adept at negotiating and who thoroughly understand the complexity of insurance claims,” Petrie says. “Another benefit? It frees your own people to focus on helping your organization deliver optimal patient care.”

Claim denial management is a core competency at Regent Revenue Cycle Management. For more information, go to www.regentrcm, or call (708) 492-0531.