Use Analytics to Identify Denials Worth Reworking

Matt Wormser

There’s lots of noise in any denial data set. Only a fraction have recoverable money. Since reworking each denial costs about $25, it’s critical to identify which denials your staff should spend time on.

Analytics will help you figure that out.

Delve into denial scenarios

In a previous post I discussed analyzing combinations of claims adjustment reason codes and remittance advice remark codes to identify the root causes for denials.

That same analysis will help you get the most return for your insurance follow-up staffing buck.

Target what you can appeal

The value is in identifying all denials with the same reason/remark codes, so they can be “worked” all at once, instead of the needle-in-the-haystack approach.

Contact the payer to get a better understanding of what’s recoverable and what’s not. Find out what you need to do to get paid.

Document what you learn

Too often people are calling the payer trying to decipher issues that other people within the organization have already researched.

Documenting the cause and resolution of specific reason/remark codes for individual payers is a central way to avoid duplicative work—and eliminate hours on the phone on hold. In your procedures and training, spell out which scenarios staff should try to recover. Don’t waste time on the others.

Have you streamlined your denials management by documenting which are fruitful to go after? Post a reply and share your success.

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