Denials Management

Donna White

Donna White

By Donna White, Principal Consultant and Owner of Legacy Consulting Services and Legacy Billing Solutions in Montgomery, Alabama.

What exactly is denials management? What are the benefits of tracking and managing your denials? Who should be tracking your denials rate? In today’s blog, we’re going to explore these questions.

Denials Management
Denials management is the process of reporting on received denials on a regular timetable, usually set by executive management. Be it weekly or monthly, depending on the size of your practice, tracking your denials types will help prioritize what payors need focused attention and where there could be gaps in your workflow throughout the practice.

Benefits of Denials Management

The goal for every practice is to have a less than 5% denial rate. For many practices, this can feel impossible to achieve. However, by measuring your denials over time, your practice can see what types of denials are causing the most problem and attack those first. Does your practice have a new provider? You may have a lot of credentialing denials. This tells your credentialing department or manager that better follow up on credentialing is needed to get that provider credentialed to reduce that denial type. Does your practice have hospitalists that often turn in charges with incomplete face sheets? This drives subscriber ID, coordination of benefits and eligibility denials. Either registration is not getting the full insurance information for the patient, or they’re not providing all the necessary information to get the claim paid the first time. It’s time to speak with hospital management to discuss their registration procedures and how they can best provide the most accurate insurance demographics to all their hospitalists.

Responsibility of Denials Management
This can vary depending on the size and set up of your practice. If you have a back office that focuses specifically on your revenue cycle, then your revenue cycle manager should be looking at these trends weekly or monthly. If you have a small practice with a handful of employees, this most likely will fall to your practice administrator or office manager. Either way, the goal is to identify and provide targeted worklists to the RCM teams to tackle each denial type that is causing problems for your practice. Instruct those working the denials to let management know of any trends they see while working the denials.

Overall, denials management requires the focused effort of your revenue cycle staff to regularly and systematically work top denials regularly until your practice reaches its goal of less than 5% denials rate. It is achievable, if your teams work together and you are regularly tracking denials to know how best to work them.

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