There is no disputing that the working of healthcare billing denials costs the practice with money left on the table, but also costs in the work needed to resolve the denials. The average cost is $25/claim to resolve and collect the charges subsequently denied. In effect, a practice is paying twice and sometimes three times to collect from carriers and patients for provider services, tests and procedures.
Today, most practices use a practice management system to manage charges and payments and denials. While there are many complex steps to this process, each system has a unique way of handling demographic data, charges, payments and denials. But they all basically do the same things……collect and store appropriate patient demographic and insurance data, provider and charge data. Accounts receivables (AR) represents all those transactions both paid and unpaid.
The “right” way to work denials may be different depending upon your practice management system and how it treats transactions, but there are some common threads that need to be prioritized to efficiently collect owed dollars.
- Learn your practice management rules and options. Every system has developed ways to streamline work-flow. Knowing your options and leveraging technology to be able to identify denials and work in an efficient and timely manner should be a priority.
- Know where you stand with denials right now. There should be a mechanism to identify denials, categorize them and look at them collectively to make some decisions about how to best make a dent in what is usually a growing and aging AR. Do you have a credentialing issue that is holding up some claims? Are there front-end errors that are causing carriers to kick back claims with inaccurate information? Are there coding issues? Use this data not only to create a plan to work denials, but also a way of putting together a plan to prevent these same denials in the future. Getting paid the first time should be your goal.
- Work the ATB (Aged Trial Balance). With this report, you can sort oldest, highest balances a and make a real difference in collections before time-limits run out on correcting. You will also be able to work denials at the account level and not the claim level. So if there are multiple denials, they can all be corrected at the same time.
- What comes in today should be worked today. It is the only way to effectively stay ahead of the denial game. Unless you have teams working on the current denials and resolving them quickly, you are spending even more money by allowing the charges to age. The older the claim, the more difficult it is to resolve.
- Use a team of people to clean up back-log. At the same time a team is focusing on the new daily denials, a team, should be working on the cleanup of old AR. Requiring people to work both new and old AR will result in aging. There is simply no way a team can efficiently do both. Split up employees into teams and attack both at the same time. When you have resolved the old AR, you may find that you can reduce staff.
There are many ways to effectively work Accounts Receivables, but the main “right” way is get it done. Don’t allow AR to age. It’s costing you a lot more money than you think. And isn’t the point to bring in more cash than you are spending to collect it?