Managing denial rates has long been a challenge for providers. In the worst case, denied claims end up as unexpected — and sometimes unaffordable — bills for patients. The challenge only seems to be growing. A recent survey conducted by the American Hospital Association (AHA) found that 89% of respondents had seen a noticeable increase in denials over the past three years, with 51% percent describing the increase as “significant.”
Minimizing loss will be top of mind for providers as the COVID-19 pandemic continues to put a strain on their resources, and minimizing or preventing denials will need to be a core part of that strategy. With that in mind, we’re offering four tips to help guide rev cycle strategies for better denial reduction in 2021.
1. Analyze and assess
In order to achieve and maintain a healthier denial rate, it’s vital to have a good handle on the factors creating problems in the first place. Keep the following in mind as you start to structure your analysis:
Review key performance indicators — Take a look at which metrics are being used to benchmark success or failure and see if it’s time for a refresh
Evaluate workflows — It’s important to have a clear understanding of how your team operates, and that you can detail workflows as step-by-step processes
Assess tools — Inventory the software you’re using and discuss with your team how it helps or hinders them
Staff efficiency — Consider the number of team members and resources involved in each step of the denial management process
It’s also important to talk to staff. Your team can offer invaluable insight on what is and isn’t working to help you develop a more comprehensive understanding of the shape and scope of the systemic issues contributing to your denial rate.
2. Reduce errors up front
Eligibility, registration, and authorization errors remain the greatest cause of denials and write-offs, so a good first step is to focus on being proactive instead of reactive. Often, it’s easy to get into a routine where errors are only addressed after they occur. But incorporating tech to verify coverage and benefit accuracy in advance can lead to higher efficiency and much less manual labor spent to correct those issues later on.
Similarly, a recent AHA report found failure to obtain prior authorization to be one of the most common reasons for a claim to be denied by a commercial health plan. In another recent survey, the American Medical Association found that 86% of providers surveyed were struggling with a high administrative burden created by prior auths.
Recent innovations have made the process simpler than ever. The right prior authorization solution can automate the process and make it simpler, smarter, and much less labor intensive, reducing manual input errors and preventing denials.
3. Cut down on manual labor
Denials are often the result of staff trying to keep track of a seemingly overwhelming number of rules and regulations while juggling various systems and filing requirements. And when your staff is overburdened, it’s that much easier for them to make simple errors or miss deadlines.
There are numerous tools available for teams who are either struggling with paper-based processes or databases without automation. With an AI-powered solution, you can streamline a number of time-consuming tasks while simultaneously automatically ensuring you’re identifying missing data or claim errors that can be corrected before they’re submitted.
It’s also a good idea to review any potential new tools with your team. Their insight will help you properly determine which solutions will actually improve their workflows, which could prove an expensive time sink.
4. Use stronger reporting tools
Accurate and in-depth reporting should be core to your strategy. Effective reporting tools let you quantify and assess the issues that influence your denial rate, allowing you to easily spot persistent workflow errors or other systemic problems that can create extra work or strain resources.
New tools powered by AI and machine learning offer more robust reporting options than ever, with advanced analytics and visualization capabilities that make it easy to explore complex data sets or identify trends. Mountains of information can now be easily managed and measured, giving you access to operational insights that will help you better understand problem areas and identify opportunities for improvement.
The wrap up
With the right tools, a solid strategy, and expert guidance, you can take a proactive approach to denials. Our automated tools make it easy for your team to streamline their workflows while reducing errors and administrative costs. With our AI and RPA platform, you can unlock the insights you need to reduce your denial rate and increase cash flow.
Waystar also offers a number of solutions to help you take a more proactive approach to your denial rate. Learn more about Waystar Denial + Appeal Management.
