Revenue cycle leaders continue to face significant stress due to regulatory burdens and persistent denials, which are exerting immense pressure on revenue cycles.
Despite having a well-functioning front, middle, and back-end revenue cycle, payers often disrupt the process by introducing complexities and constantly changing rules within their intricate, multi-tiered structures. This unpredictable behavior from payers can significantly impact revenue cycles, regardless of existing contractual agreements.
A leader has discovered that adopting a focused approach to denials management can yield significant benefits. By organizing teams based on payers, conducting regular meetings, and implementing robust data tracking systems, this leader has successfully streamlined the process of managing denials and achieved notable improvements.
According to director of reputed healthcare clinic, his denials team operates on a payer-specific basis. They emphasizes that the team possesses an in-depth understanding of the contracts, thoroughly acquainted with every detail and nuance.
And although denials issues can differ across various facilities, there are several fundamental principles that can be universally applied to enhance denials management.
Listed below are three recommendations that suggests for all revenue cycle leaders to streamline these processes:
Understand your contracts:
Understanding the contract language and your rights, beyond just the payment rates, is crucial. Unfortunately, many hospitals withhold contract details from staff members dealing with denials, putting them at a disadvantage when interacting with payers.
Always Be in Touch with Payers:
Schedule regular calls with your payer representative, ideally on a monthly basis. Share a spreadsheet of claim issues, including both payment and denial matters, before the call. This allows the payer to review them in advance and arrive at the meeting prepared with responses. By doing so, you shift the responsibility to the payer to explain the validity of denials and provide guidance on resolving them going forward.
Monitor Your Data
Utilize data tracking for denials by payer and reason to bolster your position during contract negotiations. Share this information with your managed care contracting director. When armed with irrefutable data, you increase your likelihood of obtaining concessions in the new contract.
