Denial Prevention

Denial Prevention and Increased Staff Efficiency

Denial Prevention and Increased Staff Efficiency

Benjamin Franklin is credited with having coined the phrase, “An ounce of prevention is worth a pound of cure.” It’s as relevant today as it was in 1736, especially when it comes to healthcare payor denials.

In a recent survey* reported by Becker’s Healthcare, over 500 Chief Financial Officers and Revenue Cycle leaders named their top five most time-consuming tasks. Chosen from a list of 15 different staff assignments, 76% of the leaders selected Denial Management as their number one time-consuming nemesis. Prior Authorization was second at 60% of all responses.

While denials can cause a significant amount of revenue loss, most of them can be avoided. In addition to taking up valuable staff time and resources, claim denials greatly impact the revenue cycle by delaying or reducing payments from payors to providers. Taking steps to prevent them is worth the time and investment. This is true for Physician Practice Groups of all sizes, MSOs, ASCs, Hospitals and IDNs.

Avoiding Denials with Better Data Validation… Before Posting

Denials are simply the result of a rules-set, programmed within the payor systems to look for errors. Missing information and/or improperly coded claims is simply an automated mechanism within their programming logic to reject a claim.

Data Validation is at the heart of ReMedics denial prevention. It is a critical part of our Payment Processing BPO Services. Validation helps to scrub and cleanse the data before posting. We automatically check for errors, validating all claim information needed for processing while also improving data integrity. Our payment validation process begins by applying over 200 client customized rules to find potential cash application errors before posting and routing those errors back to efficient work queues for correction. This data cleansing process significantly reduces denials, posting errors and reprocessing. 

Efficient Worklisting Tools and Documentation

Depending on your specific requirements and staff assignments, we provide our clients with auto-generated Exception Worklists that include claim and patient information, along with links to relevant documents such EOBs, correspondence, and checks. While ReMedics goal is to prevent denials from occurring altogether, we provide our clients with efficient workflow solutions to quickly get them appealed and resolved with timely and effective follow-up. This increases cash flow and decreases process delays. 

Creating Permanent Revenue Cycle Improvements 

With decades of data validation, workflow automation and systems integration experience, ReMedics can work in conjunction with any major Practice Management System, EMR or Billing application. Contact ReMedics online or call 440-671-7700 to talk about how we can help you to prevent denials and create permanent revenue cycle improvements in your business office.

*Source: The Akasa commissioned survey was conducted through the Healthcare Financial Management Association’s Pulse Survey program between July 8th and August 2nd.  Read the entire Becker’s Healthcare article at