Implementing effective claims denial management can lower your denial rate and improve your healthcare organization’s revenue. Denial prevention is the key to improving your cash flow without having to appeal your claim submissions.

Denial Management Factors:
1. Utilization Review: Prior And Concurrent Authorizations
2. Denials At Claim Submission: Administrative Denials

Management of one component without the other will not create effective denial rate reduction. To begin this task, you have to analyze claim denials for coding issues and denials for medical necessity. To successfully accomplish this, your department will most likely need additional staff.

Lori Intravichit, CEO of Sunlit Cove Healthcare said:

Payer requirements change frequently, and theirs advanced AI technology and the algorithms are constantly looking for the slightest omission in order to reduce the payment or reject the claim entirely. You need to stay on top of changes to optimize revenue capture. Hospitals and healthcare organizations must incorporate utilization review and denial analysis in their revenue cycle to prevent unnecessary costs and claim denials

Do you have the resources to fund additional staff to ultimately handle the management of coding requirements, medical necessity, and efficiency of healthcare services provided to a patient? When you consider salary + 30% average benefits package on your barely leveled balance sheet, the odds are against you that your healthcare organization will agree to additional team members. Not to mention the fact if your organization might be heading to off-season with lower admission rates.

Finding an outsourced vendor that provides both utilization review and claims denial analysis is hard to obtain. The reduction of denials depends on the correction of your process internally to prevent these denials. Your organization needs a comprehensive solution. Partnering with a vendor that has the right players on the team from all areas of the revenue cycle could get you a significant return on investment.

Sunlit Cove Healthcare Consultants provides Utilization Management directors, nurse reviewers, and claims specialists who have extensive knowledge and experience in:

• Obtaining medical necessity authorizations for payment approval.
• Responding and adapting to changing market forces and regulations.
• Ensuring continuity of care and accurate payment for that care.
• Providing process fixes for billing to prevent future denials.

We provide these services on a continuous or as-needed basis for a reasonable rate. No need to hire staff as volumes shift with the constantly changing environment. We work on a flat fee basis that will allow your budget not to fluctuate.
Contact us or give us a call at (727) 278-3009 to get started.

Free Process Review Services

Sunlit Cove Healthcare Consultants

We provide management and consulting services to help healthcare businesses run efficiently. Navigating the dynamic and complex revenue cycle management is a challenge for many health plans, health care vendors, and providers. Our consulting services are available to assist with your day-to-day operations and provide expertise in growth and change management. We manage all aspects of your enterprise from the development of the revenue cycle management process to the completion of your business cycle.

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