How to Minimize Denials

The Healthcare Financial Management Association (HFMA) reports that annually, as much as $262 billion in denied claims across healthcare organizations. With most providers facing denial challenges, it's imperative to have a sound strategy in place to tackle them head on.

Watch our short video from FinThrive subject matter expert, April Wilson, as she unpacks the top four reasons denials happen and what you can do to reduce them.

Video Transcript

Hi. This is April with your revenue recovery minute. Today, we're talking about denials.

Denials is definitely an increasing problem for healthcare providers everywhere. There are several reasons why claims get denied.

First and foremost, prior authorization. Perhaps a service needed to be approved ahead of time by the payer and it wasn't.

The second one is medical necessity. Sometimes the payer may feel that the service performed was not necessarily medically necessary, and they may deny the claim as a result. Occasionally, they may request a full medical record in order to review the case and understand whether or not it should be paid. But there are definitely ways for you to get around that.

The third reason is eligibility. Perhaps the service that was performed is not actually covered by that person's plan.

Sometimes there's just a data mismatch as well. That's the fourth reason. So a patient's name, address, date of birth, if any of those demographic information pieces don't match what's in the payer system, it can be denied.

And then finally, there's just staffing considerations. Maybe people are doing too much too quickly, and things get missed key, for example, like the CPT code. If it's incorrect based on the service that was performed, that claim is going to get denied.

As always, a best in KLAS solution is going to include great robust reporting and analytics, as well as potentially automation to help alleviate some of the human errors that can be made.

That's been your revenue recovery minute. Thanks, and have a great day.