Patient access errors are a top reason for denials, which could be costing revenue cycles a lot of cash.
Mistakes during patient access or registration are the main cause of initial claims denials by payers, a new survey found.
This doubles down on the idea that revenue cycle leaders need to address denials management and embrace tech solutions, and they should have done so a long time ago as the financial implications of denials is huge.
Over 350 chief financial officers and financial leaders at health systems and hospitals across the nation ranked the common reasons for initial payer denials and the top five reasons, in order, were as follows:
- Errors in patient access/registration
- Lack of documentation to support medical necessity
- Missing or incorrect patient information
- Physician documentation issues
- Utilization management
Other reasons mentioned included coding errors, duplicate claims, and untimely filing of claims.
Its obvious that issues with eligibility and registration occurring at the front end of the revenue cycle are affecting the reimbursement process, so what can revenue cycle leaders do?
The key to avoiding these denials may lay in automation.
Patient access plays a tremendously important role within the revenue cycle, Alicia Auman, former director of patient access at KSB Hospital in Dixon, Illinois, previously told HealthLeaders.
"If you can get it right up front, you're ensuring accuracy, preventing rework, and preventing denials," Auman said.
KSB Hospital implemented front-end technology that included automated claim verification, front-end claim scrubbers that catch errors immediately, and tools to collect copays and payments at the point-of-service.
KSB now has real-time edits that prompt the registrar to talk to the patient at the point of service, as well as eligibility verification, which automatically checks eligibility.
“Access related denials were around 21%, now they're around 7% of total denials,” Auman said.
And since implementation, KSB’s technology has prevented an average of $800,000 per month in denied charges, with more than $20 million in total savings that would have been denied, Auman explained.
“Access related denials were around 21%, now they're around 7% of total denials.”
Alicia Auman, former director of patient access, KSB Hospital
Jasmyne Ray is the revenue cycle editor at HealthLeaders.
KEY TAKEAWAYS
Registration errors are one of the main reasons for initial claims denials by payers.
Automating front end processes can ensure accuracy, prevent rework, and prevent denials, one hospital executive said.