Implementing an Effective Denials ... - Healthcare News
Implementing an Effective Denials Management Program
Rochelle Dahmen, Revenue Cycle Manager
rdahmen@ 612.253.6591
Agenda
? Introduction ? Denials - An Overview ? Defining Denials ? Understanding Your Denials ? Managing Your Denials ? Conclusion ? Questions
Denials ? An Overview
Denials ? An Overview
? According to the American Medical Association (AMA), 25 ? 30 percent of the country's total health care expenditures are direct transaction costs and inefficiencies associated with the "claims management revenue cycle".
? Substantial amount of resources are utilized while managing the basics of the claims revenue cycle
? Lack of payment transparency ? Inaccurate or unfair payment ? Administrative hassle ? Payment reconciliation and claims follow-up
Denials ? An Overview
? According to recent estimates, gross charges denied by payers has grown to an alarming 15 to 20 percent of all claims submitted
? The average cost to rework a claim is $25.00, according to the Healthcare Financial Management Association (HFMA)
? As many as 65 percent of claims denials are never worked resulting in an estimated 3 percent loss of net revenue
? Roughly 67 percent of all denials are appealable
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