Stop Denials, Increase Revenue with Digital Technologies

The St. Louis Blues started the year with the worst record in hockey. But they ended the season winning the Stanley Cup.

What does hockey have to do with healthcare payer denials? More than you’d think.

Physicians can have great individual office players, but if the group doesn’t come together as a team the results will be less than optimal. In the same way the Blues have players with specific skills who play specific positions, the physician’s office should do the same to be successful.

But just as hockey teams don’t always have the right person playing the right position, the physician office may have staff playing the wrong position when it comes to decreasing denials. One in five claims is denied or delayed, according to a recent report. Studies indicate that 65 percent of these denials are never reworked and lead to lost revenue.

These numbers are a good indicator that healthcare providers don’t have the right people in the right positions. This is because many employees don’t have the expertise or time needed to work denials. Just as the Blues wouldn’t ask their goaltender to play forward, physician offices shouldn’t expect staff to be specialists in every area of the revenue cycle. But there is a way providers can maximize their earnings by realizing every dollar of revenue owed to them.

Using data analytics, healthcare providers have the most up to date information available regarding the health system’s payer contracts. This helps physicians realize the revenue for services they’ve already provided. Digital technologies are critical to long-term success because denials are a significant problem for physicians. The Employee Benefits Security Administration reports 200 million claims are denied every year in the U.S.—and, for the most part, it’s a simple error causing the problem. But even simple errors can take hours to correct, making an automated appeals process critical to the long-term success of any practice.

Here are 7 ways physician practices can realize more revenue through improved revenue cycle processes:

1. Monitor denial management and payment integrity
2. Identify overpayments and underpayments on professional and institutional claims
3. Use contract management services to evaluate payment/reimbursement
4. Automate claim status inquiries via 276/277 transactions
5. Integrate submission and retrieval of claim status inquiries
6. Increase payer communication to staff through real-time claims status checks
7. Assist with streamlined denial identification

An automated appeals process eliminates the need to inspect each payment individually and quickly resolves eligibility and authorization problems. This reduces the time physicians spend on the task themselves, and, importantly, allows the seamless hand-off of the job to office staff. Doing so improves overall practice efficiency and the physician’s own productivity.

Like St. Louis’ NHL Stanley Cup Champions, healthcare providers have the opportunity to take 200 million losing seasons and turn it into a single winning season that lasts for years.