Daily operations require billing and collections be the top priority of the revenue cycle management operations. Retrospective analysis and reconciliation often fall by the wayside in order to have a continuous cash flow. The lack of Revenue Cycle Audit and Denial Management can lead to cash collection reduction and costly overhead to obtain the correct payment from the payer.
Root cause identification of denials by payors and reason is needed to increase the timeliness of claims payment. Targeting the top five to ten insurance payors by revenue and denial rates can determine appeal success and future prevention of denials. The internal areas that may be involved in the issue are pre-registration, utilization review, and billing. It is also important to contact the payor to resolve any denial issues that may be a result of insurance company error.
Reviewing payment turnaround time for your top 10 insurance payors can pay financial dividends to your bottom line. It is essential to differentiate between a clean claim payment vs. a secondary submission that requires your staff to intervene and resubmit the claim. Root cause identification and upfront resolution will reduce revenue cycle denials and increase payment turn around time.
Review aged account balances to determine if the account balance is correct and make adjustments as necessary. You should identify the top 5 reasons the account balances are incorrect. Work through processing issues to prevent future incorrect account balances.
This is a targeted review of accounts with credit balances. The need to determine if the balance is correct and liability sitting on the accounts are accurate. Identify any patient or governmental credits for immediate refund processing. Categorize root causes of accounts creating false credits and identify process flow correction.
2014 Advisory Board study revealed:
Claim denials may be a fact of life in healthcare, but inadequate claims denial management strategies could be leaving more healthcare revenue on the table than expected. About 90 percent of claim denials are preventable.
Our focus is to help your business grow and run smoothly. We understand the challenges faced with Revenue Cycle Audit and Denial Management. Sunlit Cove Healthcare Consultants provide professional subjects matter experts in the healthcare industry to enhance your business. Our consulting services are available to assist with your day-to-day operations and provide expertise in growth and change management.