Denials Management: Risk-based Solutions that Optimize Revenue Cycle Performance

Denials Management: Risk-based Solutions that Optimize Revenue Cycle Performance

Opportunity

In today’s environment, providers face a multitude of obstacles in obtaining reimbursement for their services. The combination of a paper-intensive operating environment coupled with gaps that often exist between systems and processes further complicates this situation. As a result, many providers are not fully aware of the significant impact denied claims are having on financial and operational performance. Industry estimates indicate that:

  • 25% - 30% of all claims are rejected or denied at some point in the collection process.
  • 5% - 9% of net revenue is directly impacted by claim denials, with 50% of this amount being lost each year. In addition, a significant amount of time, effort and cost is involved in reworking claims, submitting appeals and collecting the remaining 50% of initial denials.

Insight

We view denials management as much more than just a back-office function. Rather, we see it as an end-to-end process that – when operating properly – can have a positive effect on each area along the provider revenue cycle:

Protiviti is uniquely qualified to help you understand the true financial impact of denials on your organization, analyze and determine the root causes of denial issues within your operations, devise strategies to minimize denials and enhance operational performance, and assist you in implementing these strategies as desired.

At Protiviti, we offer a holistic business process approach to diagnosing and ultimately addressing denials and their consequences for your organization’s revenue operations. Our approach balances business processes, compliance and technology to help you achieve long-term results and sustainable improvement for your organization. Our field-tested methodologies, combined with our solid team of healthcare industry professionals with comprehensive knowledge and experience in improving healthcare revenue cycle operations, allow us to offer the help you need, when and where you need it, without compromising the efficiency or effectiveness of other business initiatives.

Impact

An effective denials management program enables you to better manage one of your most critical business risks – denied reimbursement – and facilitates the following:

  • Identification of the overall financial impact of and root causes for revenue losses from denied claims
  • Development of effective processes and procedures for monitoring and appealing claims denials
  • Design of more effective, efficient and reliable revenue cycle processes
  • Improved patient satisfaction
  • Reduction in denied claims volume, resulting in less rework and improved cash flow and cycle times
  • Improved financial performance for your organization

If you would like to learn more about our Revenue Risk Solutions or contact one of our practice leaders, please visit www.protiviti.com/healthcare or call 866.721.8340.

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