Part one of this series explored the adverse topline and bottom-line impacts of using an EHR system to manage outreach and outpatient services billing. We learned how the front-end automation functionality of a purpose-built revenue cycle management (RCM) system, used in concert with an EHR platform, mitigates these effects. This added capability decreases the frequency of downstream employee interventions and dramatically increases the number of successful claim outcomes.
The next step toward capturing lost revenue for hospital outpatient and outreach services involves augmenting claim denial management capabilities.
According to The Advisory Board, uncollectable hospital write-offs grew 90% from 2011 to 2017. The average successful appeals rate for hospitals declined from 56% in 2015 to 45% in 2017. Outpatient and outreach billings are particularly susceptible to this shift based on the relatively low dollar amount for these services and employee intervention costs to manage appeals. How can hospitals avoid these unwanted outcomes?
The solution, in part, is to employ a more robust, technology-driven denial management process designed for higher volume, lower-dollar transactions. Relevant functionality include:
In addition to claim level functionality, consolidated views enable monitoring of the overall appeals process, root cause analysis, and more effective decision-making. Common analyses include:
Productivity data further aids administration of the denials handling process, providing visibility into error processing activity, timelines, and success rates (measured in units and dollars), with drill-down capability. This information is used to delineate:
Interested in reading the rest of this series? Subscribe to our blog. View Part 3, “Capture and Exploit the Right Data” to learn more about how XIFIN business intelligence can streamline and optimize denials, productivity, and payor management view the videos below featuring our customer Cordant Health Solutions.