Leverage Your EHR to Harvest Denied Claims Revenue

Jenny Doloresco, In-Practice Technology Services Consultant Electronic Health Records (EHR)

On a number of levels, COVID-19 has made it more important than ever for a medical practice to focus on maximally efficient management of denied claims.

First, finding additional revenue is critical for most practices at this moment, as the COVID “stay-at-home” world of March through May 2020 greatly reduced office visits, elective procedures, and other typical sources of clinic income. In addition, practices have recently been experiencing some gray areas in coverage and reimbursement related to certain telehealth services, as well as audio telephone interactions with patients, so addressing denied claims is even more immediately relevant during COVID.

What are claim denials?

Denied claims are medical claims that have been sent to the payer, and have been processed, but marked as unpayable. These denied medial claims typically contain an error or a failure to receive prior authorization. The reason for denied claims can include improper billing codes, missing information, non-covered services or services being flagged as not medically necessary. Most of the time, denied claims can be updated, corrected, appealed, and sent back to the payer for reconsideration. However, this is a time-consuming and expensive process – especially when the situation can be fixed on the front end to avoid denied claims.

Claim denials account for billions of dollars in lost revenue for providers each year. This means staff is engaged in a continual process of managing and appealing claims to collect revenue. This process costs money and causes a loss of time for staff that could be used performing other operational tasks. Implementing a strategy and utilizing your EHR to manage your practice’s claim denial management process can put your practice and revenue cycle at a clear advantage and help gather otherwise lost revenue in the current environment.

How do you avoid claim denials?

Here is an overview of some key steps you can take in leveraging your EHR to prevent claim denials, handle claim denials that have already taken place, and gain more revenue for your practice:

1. If your practice is using a manual process to track denials, migrate to doing it automatically with tools in your EHR for a dramatic improvement in efficiency. Most EHRs have the ability to automatically route certain types of claim denials to specific staff members, and also allows staff to sort these by selected attributes. This way, they will have a proactive and organized approach to managing claim denials in a timely fashion.

2. Use your EHR’s ability to analyze claim denial trends. This is also imperative to gain insight on staffing or training needs within your organization. Again, your EHR has Denial Management Reporting capabilities that can allow you to see your practice’s most common claim denial reasons and the payers with the highest claim denial rates. Tracking trends and understanding the current state of your claim denials is the most useful strategy for staying ahead of the game and sending clean claims the first time, decreasing your claim denials and increasing efficiency and revenue. Keep in mind that reworking claims costs your practice money, so submitting clean claims the first time, and utilizing reporting for internal auditing can really pay off.

3. Reporting tools within your EHR can also give you a better understanding of your staff productivity. It is important to track staff productivity on an operational level to see the claim denials that have been worked on a daily and monthly basis, including monthly reconciliation of claims that have gone out and reimbursement payments that have come in. EHR reporting tools are also useful to track staff workload and determine if resources may need reallocated.

In conclusion, being proactive about your claim denial management strategy can really prevent revenue cycle disasters in the future. Tracking your claim denials and being ahead of the problem is the biggest factor in identifying root causes and taking strategic action. Utilizing reporting analytics to adjust your revenue cycle workflow and staying on top of the requirements of your payer mix should be a priority that can make a lasting impact to your organization for years to come.

Medical Advantage Group can help you find, set up, and customize all these functions, as well as train your staff; our EHR Optimization Team specializes in doing so for medical practices across the country. If you’d like to learn more about how your practice can harvest new revenue with better Claim Denial Management, reach out to us today.

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