Denials Management

Denials Management should be near the top of your list of key focus areas as you look to optimize your revenue cycle. According to some estimates, denials cost healthcare organizations nearly 3% of their net revenue annually. In recent years, denials have grown to encompass 15-20% of the billing value of total claims. That can translate to $6 million for a 200-bed hospital to over $260 million for an 1100 bed facility.[i]

Improving denials management can be difficult. There is often a disconnect between denial creation and root cause resolution. The business office handles denials but typically must interact with other departments to determine what created the problem. In many cases, the problem is then resolved without business office involvement causing the denial creating cycle to repeat over and over again.

The key to solving the denials dilemma is setting up cross-functional teams and establishing a comprehensive process based on analytics. That can be difficult for you to do as you juggle the many other responsibilities you face every day. That’s where Hayes can help.

Hayes credentialed experts will assess your current denials management program and help you develop a solution to plug costly revenue leaks caused by ineffective denials management.

The Hayes denials management service focuses on:

People

  • Training and education
  • Accountability
  • Improvement recognition and consequences for unacceptable outcomes

Workflow

  • Redundancies
  • Outcome and performance expectations
  • Payment delays root causes
  • Common sources of technical and clinical denials

Technology

  • Audit workflow
  • Data collection and analysis

Implementing long-term problem resolution is the key to effective denials management. Hayes experts work with you to install appropriate checkpoints to ensure that you remain in control.

Estimates show that nearly 90% of all denials are preventable. Developing a robust denials management program is the most effective way to yield the best results.

Denials Management

To learn more about how Hayes can help you with your denials management needs, REQUEST INFORMATION.

1,2 Hospital Denials Management…Insource, Outsource or Both, HumanArc White Paper, 2013

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