5 Rev Cycle Strategies to Combat Denials

Executives are reporting an increase in denials, putting more pressure on system finances.

Going back and forth with payers with denials is a time consuming and expensive process, and low reimbursement rates aren’t helping.

In a new survey by the Healthcare Financial Management Association, CFOs noted a significant increase in denials, which is further exacerbating financial struggles.

Of the 130 CFOs polled, 82% said the increase in payer denials has been significant compared to pre-pandemic levels. Another 84% of respondents attributed low operational margins to low reimbursement rates.

Payer denials have been an issue for revenue cycle executives, with many voicing their frustration with slow claims processing times, algorithms denying claims, and vague policy details during HealthLeaders’ RevTech Exchange.

During the event, Jonathan Benton, assistant vice president of Atrium Health, presented five methods to help leaders tackle their struggles with payers:

Prioritization – Use algorithms to determine which accounts have the greatest potential value.

Automation – Automate tasks to reduce work burden on staff and speed up revenue cycle operations.

Cultivation – Organize work to maximize system automated priority.

Analysis – Be proactive and keep track of factors impacting key performance indicators.

Resilience – Inundate payers with appeals and follow up on automated denial responses.

One strategy that OSF HealthCare has found success with is encouraging payers to utilize the system’s EHR payer payment platform to enable their automated solutions to move the claims process along more efficiently.

“I’m always promoting that [option] with the payers because it promotes automation,” Cathy Beebe, director of ministry managed care at OSF, previously told HealthLeaders. “And the more we automate with the payers, the less they bother us.”

The system's data analytics team is also performing a query to determine patterns of denials among different payers, which will enable the denials team discern commonalities or if a medical record needs to be sent along with a claim.