6 Best Practices for Hospital Denial Management

1. Identify Underlying Reasons for Claims Denial
When hospitals become aware of the reasons why a provider denied a patient's claim, it can help them prevent similar occurrences in the future as well as improve revenue generation. Not everyone in need of hospitalization is aware of ins and outs of the claims denial system. Hence, it is up to the hospital to educate patients on how their claims will be processed. And for that, Systems Hospital Surveys and Hospital Consumer Assessment of Healthcare Providers are bodies responsible for providing better satisfaction to the patients.

2. Follow a Structured Approach to Process Denied Claims
One can easily lose money by not following up on denial claims. Without a well-organized way of handling it, it becomes cumbersome to track every denied claim and will eventually lead to a pileup that becomes a headache for hospitals. Occasionally, files can be misplaced or lost which makes matters even worse. Implementing claims denial management technologies is the way to go. Hospitals are turning to technology to prevent claims misplacement. This not only helps smoothen the management of old claims but will also keep track of newer ones. Revenue from denial collection can be placed in the pipeline according to priority and this way, it leads to better revenue collection.

3. Quickly Process Denied Claims
A successful hospital denial management strategy involves a faster workflow model in handling denied claims. Once the claim is denied by the provider, the onus is on the hospital to ensure that the matter is rectified within a short duration. For that, hospitals will require a bulletproof workflow to register and track claims as and when they arrive and depart their system. This is critical because there is a deadline for hospitals to appeal for denied claims. The validity of the appeal expires if they are not followed up within the time limit.

4. Follow Up on the Developments and Results at Every Stage
It is paramount to keep tabs on all the processes because it can help parties involved to observe areas where the workflow is optimal as well as the ones where support is necessary. Hence, for this reason, it is important to preserve records of every claim whether they are paid or not. It is unequivocally important to use analytics to enhance the efficiency of claims processing. The reason for denial, the time required for completion, and time limits are key concerns in claim denial management as we move ahead toward ICD-11.

5. Identify Common Reasons for Claims Denial
Tracking common types of denials that hospitals regularly encounter is the key to having a functional denial management process. Although healthcare providers vary, the cause for denials is likely to remain the same. The common reasons behind the denial of claims are as follows -

• Misspelled names
• Non-disclosure of pre-existing conditions
• Delay in Personal Independent Payment (PIP) application
• Coordination of benefits
• Incomplete patient information
• Duplication of claims
• Missing Personal Authorization Number (PAN)

Although these reasons may seem trivial, they may expose loopholes in the strategy followed by hospitals. Carrying out frequent checks and taking necessary precautions for not just present situations, but also the future will ensure that you are perfectly aligned with the latest trends that will unfold a few years from now. When hospitals plan pre-emptive claims management strategy it will disallow the list of reasons for denial from growing.

6. Outsource Denial Management to a Servicer
Look for a provider who specializes in denial management services. Before you press ahead on outsourcing the project, it is worthwhile to ask if more money can be pulled from payers and patients, as well as whether the outsourcing company can offer a better experience to help hospitals make their patients feel more satisfied.
When you outsource denial management to a capable servicer, you will be assisted by a team that consists of subject matter experts in the insurance system and the challenges that ensue in the claims process. This will also allow you to focus on other core areas of hospital management.