Reducung Claim Denials for hospitals and health systems
Reducing Claim Denials

Managing denials is critical to hospital financial performance

In an era of shrinking payer reimbursement, your hospital needs to focus on collecting every dollar it’s owed—both from patients and from payers. Monitoring your organization’s revenue cycle yield will tell you how you are performing in these areas, and if your payer yield is trending down, you need to look at your denials.  

The first step in any denial management program is identification. While there are many standard reasons payers deny claims, it’s also true that payer rules can change often, particularly those related to medical necessity and pre-authorization. Continuous analysis of claims data will help you recognize trends that might reflect these changes. With that information, the next step is to have a protocol for notifying stakeholders throughout your organization. The goal here is to address the root cause of the denial.

Addressing denials is critical to improving your revenue cycle yield. Availity’s can help you streamline critical patient access activities in order to prevent denials.