Maintain your profitability, by developing effective, consistent revenue cycle controls.

90% of all denials are preventable at the front end.
2% first billing denial rate is the Industry Benchmark.
 

Did You Know?

1. 200 million claims are denied each year
2. 1 in 5 claims are delayed or denied due to errors
3. 30% to 40% of all claims have registration errors
4. 30% had incorrect insurance verification
5. 81% of complex inpatient claim denials are due to coding errors
 

Economic Impact

1. 80% of billing office time is lost reworking claims with an average cost of $25 per claim 
2. $17B in administrative cost is lost due to errors
3. $125B is lost due to faulty billing practices
4. $90B in improper payments by Medicaid, Medicare in 2017
 

Solutions

1. DOCUMENT, DOCUMENT, DOCUMENT! Be Specific - If the record is not accurate, it didn’t happen!
2. Ensure proper use of modifiers
3. Make certain all codes are present and accurate - this requires a multi-departmental effort
4. Work claim denials and rejections in a timely manner
5. Monitor applicable billing rules and regulations to maintain compliance

Outsourcing revenue cycle management to experts with dedicated denials management programs can be a highly profitable and sustainable alternative to:

1. Reduce billing and A/R backlogs
2. Identify root causes of denials
3. Monitor billing performance indicators
 

REMEMBER...Recurrent errors may trigger investigations, audits, penalties!

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