CAP Roundtable: Collect Data to Fight Increased Denials and Documentation

Fight Claim Denials with Data

As hard as we try to submit a clean claim, pathology practices are still faced with a significant % of their claims that are denied by both governmental and commercial payers. Once a claim is denied, the chances of ever collecting the claim are decreased, and the time to collect the denied claim is significantly increased. Either way, it impacts the cash flow of the practice. 

What can a pathology practice do to support the billing operation? Reduce the number of denials? Streamline the denial process?   

First, we need to understand what is causing the denials. We need to analyze our denials by payer, denial reason, CPT code, and ICD 10 Code.   

Once we understand what is generating the denials, we need to develop a plan to prevent denials if possible and develop a process that quickly provides the documentation to support the denied claim. 

Learning Objectives:   

  • Identify common causes of claim denial 
  • Find and analyze data from billing reports and remittance advice 
  • Develop a plan to prevent future denials 
  • Create a process for denied claim documentation 

Juanita Evans MD, FCAP
Vice Chair, Practice Management Committee

Al Harrison Sirmon
Pathology Practice Advisor 

Diana Richard
Sr. Director, Pathology and Strategic Development, XiFin

Stephanie Denham
AVP, RCM System and Analytics, XiFin