Organizational Techniques to Maximize Follow-Up Staff Efficiency
Nothing is going to completely eliminate payor denials. In fact, denials are on the rise. According to a survey of 131 hospital executives* conducted in Apr-May of 2021, they reported a 20 percent increase in claim denial rates in the past five years. The average denial rate shown in the survey was between 6 and 13 percent! In another survey, as many as 65 percent of claim denials were never re-worked resulting in further loss of revenue.
ReMedics utilizes over 180 data validation rules to prevent denials from occurring in the first place. With these automated rules in place, we correct many common issues, such as missing or incorrect patient demographic information and technical errors. We talk about this in more detail in a blog titled Isolating Claim Defects and Preventing Denials. Even with data cleansing prior to upload, however, some exceptions and denials are bound to occur.
To maximize follow-up efforts, especially with revenue cycle staffing shortages affecting cash flow, account follow-up teams need to be as efficient as possible. For ReMedics clients, automated work queues and worklists are an effective tool for follow-up success. The worklisting tools that we provide allow for staff to set priorities such as account balance, aging from billing, discharge, or last follow-up date. These parameters, combined with access to all claim and payment documentation, allow staff to focus on work that yields the most return. Work queues can be assigned to specific individuals or work groups, depending on client preference and changes in staff availability.
Using Analytics for Denial Prevention
Maximizing the effectiveness of follow-up activity with automated worklist technology also yields significant data that can lead to avoiding denials altogether. As you become more familiar with the types of denials your organization receives, patterns will emerge where continued appeals and follow-up on certain denials will result in payment, while other denials may not. Tracking these outcomes (by payor, location, procedure or specialty providers) can provide valuable information to make adjustments in patient access, claims processing, billing and follow-up efforts. For example, if a payor continues to deny certain types of services and appeal efforts do not result in payment, it may be an inefficient use of time to spend limited resources in that area. Using that denial information however, to resolve the reason why the denials occur can deliver a significant return on investment in denial prevention and avoidance.
Ongoing management and prevention of denials is key to improved business office operations and increased cash flow. A knowledgeable account follow-up staff with the right tools will be more efficient and a more valuable resource to other areas of the organization that influence the entire revenue cycle.
Talk to ReMedics about creating efficiencies in account follow-up for your organization. Contact us online — or call 440-671-7700.
*Source: RevCycle Intelligence – part of the Xtelligent Healthcare Media.