The average cost to rework a denied claim can run up to $15 per claim that add up daily and add up fast.
For many practices, there just isn’t enough time or resources to rework every denial, which can leave a lot of money on the table. An estimated $262 billion, or 9 percent, of the estimated $3 trillion in claims submitted by hospitals last year were initially denied. The American Medical Association estimates providers could collect an additional $12 billion if insurers used automated systems to process and pay medical claims.
Keeping up a solid income while adapting to always changing healthcare policies is overwhelming. You have to get ready today for the inescapable parade of evolving regulations, redesigns to payer rules and developing methodologies. Determining the issues and invigorating your main concern in the process boils down to how well you can reinforce your income and patient billing system processes. Denials are frustrating and cause a lot of disruption to your revenue cycle workflows.
Each denial means increased costs and the potential for lost revenue. Today, practices need to find new, innovative ways to reduce costly time-consuming processes like denials rework, especially with the growing financial pressure from value-based care and growing patient payment responsibility they are facing.
The main goal of any practice is to lower costs and improve outcomes. Physicians need to simplify their workflow with no disruptions nor additional administrative burdens by automating their workflows and improving the eligibility verification process which in turn can reduce denials overall. And when the number of denials goes down, cash flow is more likely to go up.
Employing technology or expert services is an easy way to catch administrative errors and reduce the number of claims rejected for formatting errors. Analytical tools will proactively identify opportunities to increase cash flow and stem revenue leakage. This, in turn, helps providers reduce the risk of audit and/or non-payment.