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Reducing Denials Management and Prior Authorization Efforts


According to AKASA survey respondents, revenue cycle leaders have identified the costliest tasks in healthcare – Denials Management and Prior Authorizations, rated as the 75% and 60% most time-consuming tasks, respectively, ultimately negatively impacting patient care. While some denials occur without warning and are simply part of doing business, prior authorizations and other delays from denials in the revenue management cycle (RCM) can be avoided or mitigated through improved management practices. Fortunately, there are steps healthcare providers can take to streamline this process and reduce the number of denials sent, improve patient experiences, and ultimately maximize reimbursement.

Why Denials Occur and How to Minimize Them

The first step is to clearly understand why denials occur by identifying the root causes. According to the Journal of AHIMA, the most common reasons for denial are:

  • Prior Authorization is required before a service is performed or medication is administered
  • Incomplete or Missing Information
  • Coding Errors
  • Medical Necessity Requirements are not met
  • Insufficient Medical Records
  • Insufficient Coverage by Payer
  • Duplicate Claims
  • Late Submissions

Having identified the most common causes for claims denials, you can establish a strategic approach to best practices and organization to mitigate errors, delays, and denials.

Minimize Prior Authorization Delays

Prior authorization for treatment takes time away from healthcare providers that would be better spent treating patients while increasing operating costs and potentially delaying reimbursement.

AAFP’s FPM Journal provides guidance on minimizing the burden of the complexities of prior authorizations to reduce time and costs in the future while meeting the needs prior authorization entails. Systemize the process as much as possible to reduce the time spent on denials management and prior authorization.

  • Use Insurer’s Forms ­— If possible, use the insurer’s forms, diagnoses, listing codes, and other essential information typically required to process a prior authorization request. This standardized approach makes it easier for staff and patients to complete the necessary paperwork.
  • Prior Authorization Education —Educate patients about coverage limitations that come from prior authorizations. Ideally, by informing them of what procedures and medications require prior authorization, they can be better prepared before needing treatment.
  • Master List of Procedures and Medications — Consider creating a master list of procedures and medications requiring prior authorization, broken down by separate insurers. If possible, integrate these lists into the electronic health records, flagging any procedures or medications that require prior authorization.

Automation Alleviates Time Constraints and Operating Costs

Automation has proven to be an increasingly important tool in the fight to reduce time spent on denials management and prior authorization while decreasing workload and operating costs. A survey by AKASA found that healthcare providers’ cost-to-collect could lower by 0.25%. CAQH reported that these automated processes could save healthcare providers almost $25 billion annually.

The Benefits of RCM Automation include the following:

  • Standardized Patient Pre-Registration
  • Greater Accuracy and Consistency in Processing Claims
  • Ensuring Regulation Compliance
  • Reduced Data-Related Staff Workload
  • Streamlined Workflow for Staff
  • Increase Staff Availability to Patients

Having accurate patient information and properly organizing and tracking patient information from the outset of patient care can reduce the number of claims denials. By automating the information-gathering process at the intake step, the identifying information and type of care being given, and additional information carries through the patient’s care cycle from intake through claims approval while freeing staff time to focus on patient care.

Optimizing RCM by Outsourcing to an Offshore Medical Coding Company

While automation is an increasingly integral part of RCM, it can be burdensome to dedicate resources to properly integrate and maintain a new and ever-evolving system within existing record-keeping processes. With the increase in automation, there is a corresponding increase in complexity. With more data stored electronically and more automated processes, greater oversight, expertise, and compliance is critical to success.

Revenue cycle management requires a highly knowledgeable team to keep updated on insurers’ policies and coverage information changes. Additionally, resources must be dedicated to documenting and adhering to evolving regulatory requirements. Healthcare providers can reduce these strains on their staff and operation budget by optimizing their RCM through an offshore medical coding company like GeBBS Healthcare Solutions. The GeBBS mission is to provide healthcare provider partners with cost-effective, expedient solutions to their RCM challenges.

By employing experienced medical coders who specialize in the intricacies of coding patient records, leading medical coding experts handle billing and claims processes, freeing your staff to focus on core competencies, especially their true calling – patient care. Additionally, you gain access to highly skilled coders at a lower cost than hiring on a team as full-time specialized employees.

GeBBS offers scalable end-to-end RCM solutions and clinical expertise to simplify your revenue cycle management processes, simplify your day-to-day operations, and offload the complexities of chart coding and billing data to specialists to improve payment rates and help meet your financial goals.

Entrusting your digital data workload to the experienced coders at GeBBS ensures that your coding and billing data is quickly integrated into existing healthcare systems. Using adaptable and intelligent proprietary technology powered by AI and Natural Language Processing, GeBBS delivers robust end-to-end RCM solutions to simplify tasks unrelated to patient care.

Technologies such as GeBBS’ proprietary Robot Process Automation (RPA) optimize your workflow by offloading mundane, repetitive, and error-prone tasks such as manual data entry far more efficiently and accurately. RPA produces medical bills quickly and accurately while maintaining records traceability and reducing costs attributable to billing. RPA mitigates issues with errors and redundancies, such as non-standardized data entry, incorrect prior authorizations, and coding errors through streamlined reporting, real-time insights, and frequent preemptive data checks.

GeBBS Experts Handle the Hassle With RCM Processes

Properly managing the denials and prior authorizations can take a lot of time and energy. By implementing offshore medical billing that integrates with existing systems, healthcare providers can more efficiently manage their RCM operations and improve their billing operations’ overall efficiency and operational costs. By entrusting RCM to offshore medical coding company GeBBS, staff can focus on their calling — patient care.

Streamline the complexities of healthcare revenue cycle management with the experts at GeBBS by contacting us today at gebbbs.com.

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