About the Session

With the rise of high-deductible health plans and pressure on reimbursement rates, many hospitals and health systems are trying to improve collection rates to maintain or boost their financial performance. Although consumer payments represent a significant portion of their revenue, providers are forced to consistently rely on correct and timely reimbursement from payers. Preventing denials can help accelerate reimbursement, improve staff efficiency and help shift the organizational culture to focus on better patient-access strategies.

While approximately two-thirds of denials are recoverable, 90 percent are preventable, according to The Advisory Board Company. However, prevention requires new levels of visibility and knowledge of where and why denials originate. It also requires staff flexibility to change the processes and workflows to which they have grown accustomed. In this session, attendees will review the critical components of denials prevention that lie within the revenue cycle.

Learning Objectives:

  • Examine data quality as it relates to eligibility and registration
  • Identify workflow efficiencies on insufficient documentation and manual processes
  • Discuss effective claims processing around minimizing coding and billing errors
  • Examine payer connections such as monitoring payer behavior
  • Identify pro-active care management: ensuing care is appropriate