Guest post by Crystal Ewing, senior business analyst and manager of regulatory strategy, ZirMed.
Denial management is an industry-wide challenge—and despite traditional approaches intended to reduce denial rates, it’s one that continues to grow. Frankly, this is absurd.
I say that because, despite the recent announcements from CMS regarding changes to how they will process ICD-10-coded claims for the first year, denials will likely still increase under ICD-10—and that’s something healthcare providers don’t need to suffer in full, because it is possible to reduce their denial rates before ICD-10. Ultimately this will be more impactful than any denial management program specifically targeting ICD-10-related denials, because the “everyday” denials will otherwise endure and continue to delay A/R long after whatever disruption ICD-10 causes has long faded into distant memory.
Here are two simple truths:
- 90 percent of denials are preventable
- More than 60 percent of denials are recoverable
So where does this leave healthcare organizations seeking to decrease denials ahead of ICD-10, a change that—despite recent announcements from CMS—is nonetheless likely to bring with it a spike in denials?
Exactly where they’ve always been—in need of straightforward best practices that actually help them drive down everyday denials that create A/R delays, back-office backlogs, and an unreliable revenue cycle.
Step 1: Thoughtful Automation
Let’s step through a common process for working denials, just to clarify why it’s such a headache.
Here are some time-study figures—per each denial, staff spend:
- 4 minutes identifying the denial and routing it appropriately
- + 10 minutes gathering information
- + 30 minutes compiling and filling out appeal letter and materials
- + 5 minutes just documenting all their activity related to the denial
- and visit/log in to the associated payer’s website for 25 percent of denials
That is unacceptable—which is an opinion. But it’s also unnecessary, and that’s a fact. Each of the time-consuming manual processes mentioned above can be eliminated or significantly reduced through thoughtful automation and workflow-focused software development.
Reducing research time and enabling staff to easily resubmit denied claims are two of the biggest denial management time-savers—period.