Claim denials are an inescapable problem for hospitals and health systems throughout the country.
David M. Hamilton, vice president of Aurora Healthcare Resources: It is valuable to implement a process requiring your follow-up staff to manually review and capture a root cause on all (at-risk) denied and aged-unpaid account inventories. Payer 835 data can be easily utilized to capture appropriate denial claim adjustment reason codes and claim level remark codes, but also taking the extra step of requiring staff to capture an accompanying root cause enables your organization to monitor and compare payer denial processing accuracy, and drive constructive dialogue back to the payer if needed.
The payer 835 and staff captured root cause data can be utilized to trend, drive dialogue and provide supporting detail to identified internal problem areas or users for correctives and training purposes.
Implementation provides an excellent opportunity to establish a documented process and set trending choices for your staff to follow when touching denials and all other at-risk accounts. Initial results (post implementation) provides insight into follow-up staff competency and an opportunity to provide training.
To learn more about claim denials and how healthcare organizations can reduce them, access this story from Becker's Hospital Review.
If you would like to share your RCM best practices, please email Kelly Gooch at kgooch@beckershealthcare.com to be featured in the "RCM tip of the day" series.
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