RCM tip of the day: Use analytics to reduce denials

Data is one of the optimum tools healthcare organizations have to reduce denials and improve revenue cycle management performance, according to Gina Stinson, vice president of managed care services at Alpharetta, Ga.-based nThrive.

Ms. Stinson shared the following tip with Becker's Hospital Review.

"Use data to target process improvements to get the best results. Hospitals can better identify why and when denials occur by proactively managing denial data and looking at the specific reasons for [a] denial. Hospitals [that] successfully avoid denials analyze denial data across multiple data dimensions. One example of this is analyzing denial reason by patient type to determine where high volume denials are occurring. Doing this enables hospitals to identify, at the highest level (inpatient, outpatient, emergency room, etc.) where to apply ... their prevention focus.

"Examining denials month over month provides hospitals the trended data insight to address defined opportunities for improvement, and to implement corrective actions to prevent or mitigate future denial occurrence. It is especially important to monitor this information in combination with payer policy and clinical guideline changes to quickly measure impacts following such changes. Look for a consultative partner, enabled with a powerful analytics platform, to help you make sense of your denial data and target process improvements to protect your hospital's revenue." 

Read more advice for improving RCM performance here.

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.


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