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Related Experiment Videos

Two numbers you need to know.

Bernie Citerone1, Bill Phillips

  • 1St. Francis Hospital, Wilmington, Del, USA. bciterone@che-east.org

Healthcare Financial Management : Journal of the Healthcare Financial Management Association
|October 6, 2004
PubMed
Summary
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Hospitals can improve payment timelines by tracking managed care denial and recovery rates. Analyzing these metrics helps assess payer performance and contract compliance for better revenue cycle management.

Area of Science:

  • Healthcare Administration
  • Revenue Cycle Management
  • Health Insurance

Background:

  • Effective revenue cycle management is crucial for hospital financial health.
  • Denial management and payer performance directly impact prompt payment.
  • Understanding payer contract compliance is key to optimizing revenue.

Purpose of the Study:

  • To evaluate the utility of managed care denial and recovery rates for assessing hospital denial management.
  • To determine how these metrics can inform payer performance evaluation.
  • To guide hospitals in focusing efforts on payer contract compliance for prompt payment.

Main Methods:

  • Analysis of managed care denial rates.
  • Tracking of recovery rates for denied claims.

Related Experiment Videos

  • Assessment of payer performance based on denial and recovery data.

    • Main Results:

    • Managed care denial and recovery rates serve as key indicators of denial management effectiveness.
    • These metrics provide insights into payer performance.
    • Focusing on payer contract compliance, informed by these rates, leads to improved payment timeliness.

    Conclusions:

    • Hospitals can leverage denial and recovery rates to enhance their revenue cycle.
    • Data-driven assessment of payer performance is essential for optimizing contract compliance.
    • Strategic focus on these metrics facilitates prompt payment and financial stability.