Despite these challenges, all is not lost, and practices can overcome them effectively. To overcome them requires a two-pronged approach.
Practices should first find their initial denial rates and look for solutions to deal with these denial issues. Data analytics offers the perfect tool to do this and could point to the root cause of the denial issues.
Secondly, practices should investigate registration and pre-service issues. Denials often originate at the beginning when front desk staff admits patients who don’t meet the eligibility criteria for payments. So, eliminating this and paying careful attention to patients’ eligibility beforehand can go a long way in eliminating a significant portion of denials.
To achieve this, practices should have an efficient pre-authorization process that requires authorization ahead of time. Here, the information goes from the practice to the payer who refuses approval and sends an answer back to the practice.
To improve their pre-authorization processes, practices should consider:
- Automating their pre-authorization screening processes, which make it easier for staff to validate claims.
- Automating payer policy maintenance and be stringent to reduce administrative work.
Practices should also ensure proper and effective reporting keeping the entire process transparent and make it easier to understand why payers reject claims. Ultimately, this could prevent future denials.