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Billing: Work those denials

Billing: Work those denials

Kit ShellhouseQ. Revenue is written off at the end of every year.  As an owner, what is one thing I can start implementing right away that would make the most significant impact going into the new year?  

A. A lack of denial analysis is an area that costs providers deserved revenue (write-offs), if not acknowledged.  

The loss of revenue originates with a lack of initial and ongoing training, improperly worked denials and inconsistent analysis. In doing so, opportunities are lost along with revenue, year after year.  

Posting denials in the billing system allows the extraction of data elements and allows for trending to understand “lost revenue.” For example, timely filing, eligibility, invalid HCPCS/modifiers and more. Make studying historical data and past trends a priority. If denials are not posted in your billing system currently, make this process change a matter of importance in the new year. Focus on the largest group of current denials "by type," which holds the highest revenue, with timely filing as the driving force.  

Work viable denials to stop the bleeding so as not to repeat the past. Implement appropriate workflows and determine production parameters for daily and weekly assignments for all team members involved. The processes will run parallel as the team properly works denials and is re-educated on the proper steps to avoid denials in the future. 

Through analysis, the goal is to confirm the "cause and effect" and use that information to create training materials for current and future employees. For example, eligibility denials will decrease significantly with education/training on the front end in the intake department. Identify, dig in, determine the cause, discover opportunities for process improvement and then implement.  

The ongoing analysis of denials each month will decrease the chances of a bottleneck, in turn decreasing year-end write-offs. That is just a start, but a start in the right direction.  

Kit Shellhouse is vice president, ECS North. Reach her at [email protected]

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