AquinaApril 23, 2019

Three Ways To Prevent Rejection In Claims Management

Three Ways To Prevent Rejection In Claims Management

In a perfect world, the end of the revenue cycle management process (RCM) would include a 100% rate of claims payment and a 0% rate of claims denials. Unfortunately, this is not the world in which we live. However, there are ways to strengthen RCM processes and identify certain common issues ahead of time in order to make this final aspect of the process run more smoothly, ensuring an uninterrupted flow of revenue through hospitals and practices.

How common are claims denials and rejections?

According to an American Academy of Family Physicians (AAFP) report, healthcare claims denials across the industry average between 5-10%. The rate of rejection for private payers is much lower (.5-3%) than for government programs like Medicare (closer to 7-8%).

What do claims rejections cost the healthcare industry?

A 2017 report by Change Healthcare examined this question and found that the typical health system risks losing $4.9 million annually due to claims rejections. It also found that 9% of an estimated $3B in charges were initially denied, and even though up to 63% of denied claims were likely recoverable if challenged, it would cost almost $9B in administrative fees in order to get that potential revenue back. This is clearly not a sound investment.

How can providers prevent claims denials and rejections?

The Advisory Board published a study in 2014 stating that approximately 90% of claim denials are preventable, and most can in some way be linked back to making changes to the way claims are handled as part of the overall RCM process.

  1. Prevent, don’t cure: Creating a culture that focuses on preventing claims denials in the first place, rather than managing denials once they come in, is job number one. Focus on ways in which an RCM can be optimized to ensure as few mistakes as possible before a claim goes out the (figurative) door.
  2. Automate it: Manual claims management is still the norm for almost ⅓ of healthcare providers. Moving to a more automated process ultimately saves time and money, by decreasing administrative costs on the front end and helping to ensure cleaner claims on the back end.
  3. Clean up your act: Speaking of clean claims, rolling out a more automated claims management process means more simplified and easier access to the seemingly-unending maze that is individual payer rules and codes. This makes it much more likely that submitted claims won’t be denied for common issues like medical coding errors.  

How Via strengthens provider RCMs.

Even the best-organized practices can produce claims that are ultimately denied, leading to revenue gaps that can affect everything from payroll to purchasing. This is what makes Aquina’s Via solution such an attractive solution for many providers. Via is integrated into the claims management process for the sole purpose of expediting insurance reimbursements, so even when reimbursements are slow or claims are challenged, a practice’s bottom line is able to remain healthy. With integration already in place with leading EHR providers such as athenahealth and Kareo, getting started is easy. Contact Aquina Health today and find out how.