When it comes to denial management, it is important healthcare organizations target the right accounts, according to Tara Dwyer, vice president of audit operations at XSOLIS.
Ms. Dwyer shared the following tip with Becker's Hospital Review.
"Preparation, analytics and identification remain the most crucial components of the appeal process for retrospective denials. Without the right preparation, differences in regulation, type of service, claim age, and IT system type can all adversely impact your inventory of cases. Solutions that document physician concern and relevant information at patient presentation offer insight into gaps in process or procedure, while analytics that assess both clinical and financial data to create a substantive, narrative-driven appeal lend your efforts a higher probability of success. And clinical scoring algorithms, whether internally crafted by your IT department or through external vendors, ensure that cases with the greatest likelihood of success are identified sooner and the best defense of the claim is fielded. In conjunction, each of these components create a more effective back-end denial resolution process, safeguarding your profitability."
Read more about 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.
More articles on finance:
10 cities with most, least expensive hospitals
Lawsuit: Epic's software double-bills Medicare, Medicaid for anesthesia services
UPMC to invest $2 billion in 3 digitally-centered specialty hospitals