Healthcare organizations seeking to reduce claim denials should first focus on the front end of the revenue cycle process, according to Ryan Feldt, manager at ZirMed, a provider of cloud-based revenue cycle software and predictive analytics.
Mr. Feldt shared the following tip with Becker's Hospital Review:"The front office holds the keys to preventing the most frequent causes of denials, including ineligible/uncovered services, failure to obtain prior authorization, lack of medical necessity, incomplete/inaccurate patient demographic information and services covered by another plan or payer. Nearly all eligibility-related information can be uncovered and confirmed prior to the time of service — by leveraging effective and accurate patient eligibility verification technology which can save your staff time and increases their effectiveness, as compared to manual methods. Even if all of the necessary patient information isn't verified ahead of time, it can be quickly verified or amended as part of the check-in process when the patient arrives — so that the patient knows exactly what to expect, and so that you maximize the likelihood of the most accurate and up-to-date information heading downstream to your coders, billers, documentation specialists and others involved in your RCM workflows."
To learn more about reducing claim denials, access this story from Becker's Hospital Review.
If you would like to share your RCM best practices, please email Kelly Gooch at kgooch@beckershealthcare.com to be featured in the "RCM tip of the day" series.