8 Denial Management Best Practices for Hospitals

1. Know the Stats
Before you dive in to tackle the claims denial, it is important to know the initial denial rate, dollar rate, and the claims rate. This will help you understand the reasons for the high denial rate in your organization. This will also open up new opportunities to improve the processes and cut the problems.

2. Keep the Process Organized
Losing track of the denied claims will lead to diminishing your healthcare organization's revenue. If the number of denials keeps on increasing, it will lead you to some serious administrative problems. Thus, an organized denial management process can help you keep track of all the claims. You can leverage HIPAA credited tools and technologies to keep track on the submitted claims.

3. Identify Denial Trends
Quantify and categorize the denials by tracking, evaluating and recording the denial trends. You can take the help from your physicians and payers. You can also leverage the expertise of your outsourcing partner. They will help reduce the claim denials and improve compliance of your medical facility. Put more emphasis on data and analytics. If you can collate and find the reasons for the claim denials, you can identify the core issue and rectify it.

4. Complete Denials Quickly
Whenever you witness a claim denial, you should follow a validated process to get that denial corrected, preferably within a week. This is possible using an established workflow which will track the claims as they enter and leave your system.

5. Create a Team
Create a team to analyze and focus on denial trends. Find out the resources that can mete out the denials. Also, leverage their expertise to put in place solutions and track and report the development. All departments must be involved and the meet regularly to discuss important issues, key reasons for denials, and how to permanently correct them.This will set up claims denial management benchmark, reduce the backlogs, and help recognize the root causes of denials.

6. Keep the Payers Informed
The resolution of the claim denials issues can also benefit the payers. A collaboration between the payers and your healthcare organization can help in addressing the issues in a more efficient manner. This will also help in achieving highest system efficiency within a short time.

7. Choose Quality over Quantity
Everybody is looking to work on as many claims as possible. However, the best way to manage the entire process with a limited number of resources and time is to follow up with the claims which are already addressed. This will help in getting more quality claims rather than several claims which do not yield anything.

8. Track the Progress
This is one of the most important practices while dealing with denial management. It helps your organization to know which areas are doing well and which needs improvement. Both the wins and losses must be documented for future analysis and improving system's efficiency. This will help you work on the improper coding and determine whether a service was covered in the claim or not.
Automating denial management processes also give you plenty of time to rework on the rejections.