Healthcare organizations consistently seek decreases in their medical billing denials to improve revenue cycle performance. They can achieve this by focusing on edits in their patient accounting, EMR or claims management system workflows, according to Kamron Lachney, vice president of hospital operations for Alpharetta, Ga.-based Change Healthcare.
Mr. Lachney shared the following tip with Becker's Hospital Review.
"Often denials come back with generic coding explanations that can lead to incorrect assumptions about why claims were denied. To keep it from happening again, trace claims with the same reason codes and do root-cause analyses to find the true reasons for denials and add custom medical claims edits or place existing edits earlier in the appropriate system workflow. You may also need to apply modifiers not only in the edits but in the clinician's workflow or with the case management team as they identify services rendered for the claim. Each of these scenarios requires consistent and timely problem-solving to keep edits up to date and claims moving toward adjudication."
Additionally, "denials management and resolution are time consuming and results don't come overnight. Once a root cause is identified, it can take weeks of follow-up to correct the internal issues that led to the denial. A knowledgeable, dedicated mitigation team; current technology; a sound strategy and constant attention are essential for a robust denials resolution process. If your teams aren't robust enough to handle these tasks on top of their everyday role, consider outsourcing to an experienced partner who can help establish medical billing benchmarks, reduce backlogs, identify root causes, and augment your revenue cycle team."
Read more about reducing claim denials here.
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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