Melissa Fielitz Nov 9, 2023 8:40:50 PM 4 min read

How to Reduce Claim Denials With RCM Automation

You’ve heard the saying: “Work smarter, not harder.” In the Revenue Cycle industry, this is especially true. Clean claims drive cash in the door quickly, so efficiency and automation are critical for success. In Revenue Cycle Management (RCM), even scenarios that seem simple on the surface can be difficult – or unnecessarily time consuming – without automation, processes and tools to collect and organize your data.

Here are some statistics to consider:

  • Front-end denials currently make up 41% of the overall denials in the Revenue Cycle
  • Of those, approximately 22% are due to registration and eligibility issues

So, how do you start working smarter when it comes to RCM to minimize denials and improve cash flow?

First, ensure that your team is checking insurance at every appointment check in. This alone will drastically reduce denials. It’s important to provide your RCM staff with the necessary tools that allow them to quickly turn claims around and get them out the door. The alternative – logging into each payor’s website or, even worse, flipping the claim to private pay (aka the “black hole”) – will more than likely result in the claim being forgotten and turned over to bad debt.

Next, implement a program that can identify the types of denials you are receiving. This will provide visibility into your most frequent denials and allow for more effective and efficient workflows. For example: Is there a payer problem? Is there a particular specialty with a higher volume of denials or denial type? Is it a specific provider or an authorization problem? All of these and more can be identified with the correct program. With 41% of denials coming from the front-end, you can quickly begin to develop a roadmap for education or new processes.

Lastly, utilize an insurance verification tool where you can verify insurance for each patient in one place. Relying on individual payer websites is inconvenient and inefficient. Not only can an insurance verification tool identify important benefit information; it can also confirm updated addresses and other demographic information to help ensure accurate billing to both payers and patients.

Once implemented, these processes and automations will allow your team to more effectively manage claims, leading to enhanced cash flow. They’re simple ways to worker smarter, not harder, to optimize your healthcare business.