Dealing with Payer Denials
We are losing millions of dollars per year to payer denials.
Problem
Payer denials are a major challenge for healthcare organizations. Denial rates of 7 to 9 percent are common, and many organizations experience overall rejections of 10 to 15 percent. Solving the problem is difficult, because administrators are often unable to identify the source and cause of high denials.
Our Approach
We help our clients reduce denials by aligning technology and processes for optimal claims performance. First, we configure existing practice management systems to yield detailed denial data. Next, we reorganize key processes and staff to enable efficient follow-up on denied claims. We then analyze data to identify the root causes of denials (often at the code level) and work proactively to correct problems at the source.
Further Resources
- A Six-Month Plan for Reducing Denials
- Physician Employment: This Time Around, Give Finance a Leading Role
- Designing Effective Compensation Plans for Employed Physicians
To find out how Health Directions can help your organization reduce payer denials, contact us today!
Case Study
A 130-physician medical group struggled with a denial rate of 13 percent on total annual charges of $285 million. Health Directions reconfigured management information systems to provide robust denials data. We then used tracking and trending to uncover the root causes of the group’s denied claims and implemented focused process improvements. Within months, the group’s denial rate was cut to 6 percent. Annual net revenue increased by over $6 million.
