Claims Denial Management Essay

Claims Denial Management Solutions claims denial management and related analytics solutions are showing big opportunities for hospital revenue cycle gains.
When it comes to improving the hospital revenue cycle, one bright area with emerging technology solutions is claims denial management with related analytics reporting. Two recent studies show how these solutions are helping to greatly improve cash flow and collection results, as the industry transitions to new goals and policies being set by CMS and related legislation.

"...the industry is essentially on the cusp of all providers needing a modern and effective way to handle denied claims in lockstep with the transition to value-based care and, to a lesser extent, the upcoming Oct. 1, 2106
Another survey from Navicure found that a majority of healthcare organizations using revenue cycle analytics solutions were able to improve key performance indicators, including claims submissions. According to the authors, "The majority of survey respondents were executives (42%), practice administrators (35%) and billing managers (22%). Respondents represented a broad range of specialties and sizes: 43 percent from organizations with one to 10 providers; 27 percent with 11 to 50 providers; 9 percent with 51 to 100 providers; and 21 percent with more than 100
And, the Revenue360 system includes a Claims status module that initiates a real-time claim status request during the claims follow-up process. Within seconds, claim status is verified and the user is notified with a customized response and suggested next steps based on the facility business rules, using automated intelligent guidance. This software is designed to address the challenges hospital financial teams face each day. A recent post by Hafid Mirza, a medical billing consultant, on LinkedIn listed the top 10 major sources of