Denial Management: Making the Change
Stop Living in Denial
Denials continue to cost providers millions of dollars each year, not only in claims denied but in resources dedicated to denial and appeal management programs. Of the $3 trillion in claims submitted by hospitals in 2016, an estimated 9 percent of charges were initially denied.1 As many as one in five claims are denied or delayed, according to PNC Financial Services Group.2 For the typical health system, that equates to as much as 3.3 percent of Net Patient Revenue, an average of $4.9 million per hospital, at risk due to denials.
According to the Advisory Board, however, about two-thirds of denials are recoverable, and 90 percent are preventable. Hospital leaders must work aggressively to prevent denials while continuing to fight those that occur. This requires consistent processes, reliable tools, and collaboration between all areas that support the denials management program.
Moffitt Cancer Center Reduced Certain Denials by Half
At Moffitt Cancer Center in Tampa, Florida, a robust denial prevention program resulted in reducing denials from 14% of gross charges to 8% of gross charges billed. The process involves a multidisciplinary team, a data-driven strategy, a preventative approach and a missional, patient-centric perspective that extends across the organization.
How the Trace platform works to prevent denials
CENTRALIZED MANAGEMENT OF HEALTHCARE COMMUNICATIONS
Convenient access to critical healthcare communication – voice, fax and image – is proven to improve hospital financial performance, physician/staff alignment, patient experience, compliance and patient safety/quality.
The Trace platform offers tools to capture any interaction, tie it to the patient record and make it immediately accessible across the enterprise for more efficient scheduling, authorization, coordination and reimbursement of care.
Available as a single-department or enterprise-wide solution, and with tools to meet the specific workflow needs of each and every hospital, the Trace solution can be customized to meet the unique processes and data needs of each service area. Remote employees also have secure access to all captured information, giving them data they need to complete work efficiently from anywhere.
The Trace solution establishes a central repository throughout the patient continuum. From processing an incoming faxed physician order to monitoring the quality of a post-discharge follow-up phone call, the Trace platform connects disconnected data in the revenue cycle to create a more complete patient record.
Learn more about the Trace platform and see how it could positively impact communication management for your healthcare organization.
The Trace solution allows your team to become 100% paperless, with seamless integration with your hospital or health system’s EHR, and comes with built in dashboards to help you, as a manager, monitor and track team performance, quality, compliance, and consistency. With the Trace Anywhere solution you have the option to get:
- Tracker™– An intuitive web interface of voice, fax and electronic communication. Records are indexed by patient and other custom criteria for easy search, sort, delivery and retrieval.
- PixCert® – Capture web pages, patient records, scanned documents and images through any web-enabled PC. The tool captures activities performed through web sites, electronic documents and emails. Captured images are indexed and can be routed through Trace or electronically faxed to any outside party.
- FaxCert® (if enabled) – Facilitate electronic faxing – eliminating the need to print, scan and manually fax documents. The tool automatically captures both inbound and outbound faxes, along with details such as sender/recipient, date/time and proof of receipt. Faxes are digitized, indexed by patient and available for retrieval and routing through Trace. Alerts provide notice of new faxes, unsuccessful transmission and delivery confirmation.
- Voice On-Demand™ – Facilitate user-initiated recording of incoming and outgoing calls and voicemails. A hardware connection between the phone and PC gives users the ability to index, bookmark and add comments to calls while recording.
- Trace Quality Assurance™ – Used to perform quality assurance of staff communication by one manager. Custom scorecards and reporting tools give hospitals the ability to track and trend quality scores by team, agent and question.
THE CONSOLIDATION ENGINE: TRACKER
Tracker is an intuitive web interface where voice, fax and image are aggregated and indexed by patient for easy search, sort, delivery and retrieval.
- Search: search using simple and advanced criteria; view saved searches; batch fax and print records
- Patient View: view all recorded communication for a particular patient visit
- Fax Management: reconcile new faxes; notify other users of faxes; annotate, reserve and assign faxes
- Voice Management: index recordings to patients; filter and notify other users of recordings
Consolidate content from any medium including voice, fax and image. Content is centralized and easily accessible by patient, document type or any custom field created for indexing, reporting and business intelligence.
- Reports and Dashboards to monitor individual and team performance, compliance and collaboration
- Trace Quality Assurance (TQA) to monitor and track verbal communication consistency, and now, screen recordings for reliable quality scoring, quality and compliance
- Tools to measure productivity