Service Solutions: Denial Management

The physician has seen the patient. The charge has been entered. The claim has been filed. Now the insurance company should pay, right? Well, the answer is "maybe."

• Up to 25% of claims can be denied by payors. Meaning, no payment will be made unless action is taken.
• Improper denials are the leading area of physician revenue loss.
• Denial resolution is a critical area for the revenue cycle process.

There is increasing pressure for physicians and administrators to identify areas where revenue is lost. Through an intense evaluation that tracks denials by type and cause we can improve the revenue cycle process to reduce future denials.

Not all denials can be prevented on the front end. SSC has developed a robust workflow, utilizing a powerful denial subsystem to post denials at the invoice level with specific action codes. Utilizing the strength of the IDX system, these codes are then routed to specific work queues for follow up. This well constructed electronic process allows for solid management, resulting in an industry leading denial resolution rate.

Our major focus is to understand the origin of payor denials and implement "A best practice approach" to prevent denials from occurring. SSC identifies denial trends looking at the scope, causes and performance versus past time periods. SSC then identifies performance on denied charges compared to industry average and budget expectations. We then can measure the current financial impact on your organization and create an action plan to address the denials. Attention is placed both pre-denial with preventative maintenance and post-denial with integrated tactics throughout the different stages in the life of the claim's resolution.

SSC offers a complete reporting package that outlines all of the above markers monthly to identify and monitor problem areas. Denial Management allows data to explain areas of the organization that need immediate improvement to prevent future denials, establishing accountability throughout the organization.