How to Win the Battle of Denials Management

Blogs, Denials

Proof! Insurance Companies Demand It. Does Your Team have the Resources to Produce It?

Every day in every hospital and healthcare organization across the country, teams are faced with a common challenge that is as old as the practice of medicine itself. Even under the best of circumstances, hospitals have disputes with insurance payers over what treatments are and aren’t authorized and at what levels of compensation coverage.

Oftentimes, authorization information is found online via payer websites, but more often, this information is sent via fax or communicated verbally between the payer and the authorization team at the hospital. In some cases, authorizations are even mailed and scanned into the patient’s record.

The big question is what level of effort does it take for the average organization to respond to an insurance denial and provide proof of previously “authorized” services? For many hospitals, that level of effort is no simple feat and typically involves locating paper files including conversation notes and faxes, printing out information from the electronic health record (EHR) and bundling it all up to send either by mail or electronically.

Imagine having to go through that process for a patient stay of 20 days that’s being denied due to a lack of authorization. The supporting documentation needed to help the hospital make its case could take a box or two depending on the severity of the condition being treated and the general accessibility of the hospital’s medical records system. It could take hours or even days to pull all of that data together, and even then, it’s hard to be absolutely certain that every pertinent piece of information to support the claim is included. Finding the conversation notes scribbled on a notepad can be tricky unless that note is filed in the patient’s chart – which is hard to do with an electronic medical record.

Now, imagine being able to pull all of that information electronically – including printed notes, authorization phone call recordings, face-to-face patient conversation recordings discussing patient responsibility, faxes and screen captures of online authorizations and emails. The Trace® solution from Vyne Medical enables hospitals to do just that – track all communication events by patient and batch authorization data (or anything requested) together in a single, easily transferrable file. All the proof needed to challenge any denial or discrepancy is available, easily accessible, and intuitively indexed to the patient record.

Proof like that is found in the data from Lowell General Hospital (LGH) where the hospital went from losing approximately $900,000 in gross revenues per year due to notification denials for inpatient admissions to now losing less than $75,000 annually – an improvement of more than 90 percent.

In addition to helping overturn denials, leaders at LGH were also successful in leveraging Trace to manage the pre-certification process with payers. According to William Wyman, Vice President of Revenue Services at LGH, “In the area of pre-certifications alone, the amount of revenue lost to denied claims plummeted from $250,000 a month to just $5,000 a month, improving the hospital’s net reimbursement by nearly $3 million a year.”

The Trace solution is easy to use, providing business office and financial services teams the ability to capture multiple documents that may reside in various places – within the EHR, on paper and in conversations – and combine them into one patient-centric package that puts the proof to successfully fight denials well within reach. ​ ​

Let Vyne Medical show you how Trace can help drive value and decrease denials for your business office and financial services teams as well as other departments within your organization. Contact us to schedule a call with one of our solution experts today.

To connect with a Vyne Medical representative, click here.


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