Enterprise Denials Management
Enhancing Your Enterprise Denials Management
At Incisive Consultants, we understand the complex and ever-changing landscape of healthcare reimbursement. We are here to help healthcare organizations efficiently manage denials, maximize revenue, and optimize the claims process. Our comprehensive denials management services are designed to tackle the challenges faced by providers, ensuring they receive the reimbursement they deserve.
Real-World Example of Enterprise Denials Management
Incisive Consultants helped a regional health system in the Midwest reduce denials related to eligibility. His team’s analysis uncovered issues in the insurance verification process, such as timing and accuracy. By making workflow and policy changes and optimizing technology, the client was able to improve the collection of insurance information and Real-Time-Eligibility feedback.
This resulted in an astounding 80% decrease in eligibility-related denials within just three months.
What steps lead to this outcome?
Our four essential pillars are the foundation of our successful engagements. Here are some examples of the activities we perform within each pillar for this service offering.
Value Targeting
Calculate total net revenue improvement by calculating the difference between current performance and industry benchmarks for denials write-off %. Use a similar calculation for cash acceleration based on the number of open denials.
This helps to set a boundary for the best case scenario of available improvement.
Determine the floor of net revenue improvement by stacking together discrete issues impacting denials write-offs. This same exercise is performed to determine cash acceleration for claims with open denials.
This helps to set realistic expectations of what is achievable and prioritize the issues that will have the biggest impact on revenue and cash flow.
Create and lead an interdisciplinary Enterprise Denials Workgroup with representation across clinical operations, patient financial services, and IT.
This ensures that everyone who is involved in the issue resolution process is aware of the issues and is working together to find solutions.
Assist clinical operations and patient financial services with understanding the best options available to resolve the issue.
This helps to ensure that the best possible solutions are implemented.
Assist IT with creating, testing, implementing, and training end-users on solutions to issues that are the greatest impacts on net revenue and cash acceleration.
This helps to ensure that the solutions are implemented correctly and that end-users are able to use them effectively.
Reporting
Process Improvement
Validate or dismiss stakeholders’ assumptions regarding the root cause of denials and organization impact through data analysis.
This helps limit time spent on issues that are of lower impact and gives stakeholders the information to help them to make informed decisions.
Create executive-level dashboards that show progress on implementing potential solutions to denial issues and trending denial data like open denial counts, amounts, and denial write-offs.
This provides senior management with visibility into the progress of the Enterprise Denials Management program and helps them to make informed decisions.
Create a RACI (Responsible-Accountable-Consulted-Informed) matrix to accelerate issue resolution, approval, and communication for denial issues.
This helps to ensure that everyone who is involved in the issue resolution process knows what their roles and responsibilities are.
Change Management
Create tip sheets and quick reference guides to flatten the learning curve for end users for new or changed workflows.
This helps to make it easier for end users to learn the new workflows and increases adoption.
Enterprise Denials Management
Don't let denials hinder your revenue cycle. Partner with Incisive Revenue Health and unlock the potential for increased revenue and streamlined operations. Contact us today to learn more about our comprehensive denials management solutions and how we can assist your organization.