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Using technology to improve denials management
Debra Schardt1, Patrick D Harkins
1Medical Learning, Incorporated, St Paul, Minn, USA.
Summary
Denials management technology aids healthcare providers by collecting data to prevent future claim denials and improve revenue recovery. This technology enables proactive clinical documentation enhancements and strategic responses to payer denial tactics.
Area of Science:
- Healthcare Administration
- Health Informatics
Background:
- Healthcare providers face significant financial losses due to claim denials.
- Inefficient denials management processes hinder revenue cycle optimization.
Purpose of the Study:
- To evaluate the impact of denials management technology on healthcare revenue cycle.
- To identify key functionalities of technology that prevent claim denials.
Main Methods:
- Analysis of data collected by denials management technology.
- Review of process changes implemented based on data insights.
- Tracking of revenue recovered and payer denial trends.
Main Results:
- Technology facilitates data collection for proactive rule creation, preventing downstream denials.
- Improved tracking of recovered revenue aids in responding to payer strategies.
- Enabled proactive clinical documentation enhances claim accuracy.
Conclusions:
- Denials management technology is crucial for optimizing healthcare revenue cycles.
- Data-driven insights from technology empower providers to reduce denials and improve financial performance.