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Prevent Claim Denials and Manage Appeals Like a Pro

Posted by eSolutions on Nov 20, 2018 9:30:00 AM

Denials can hit your healthcare organization where it hurts.  According to MGMA, the average denial rate of a physician practice ranges from five to 10 percent. The median 350-bed hospital saw average write-offs from denials rise to $7 million in 2017.

No provider is immune to claim denials. While a prevention plan is critical to maintaining a healthy body, it's also the key to a revenue cycle that's in top shape. When prevention alone isn't enough, your organization needs a thorough denial management process.

Denied claims lead to payment delays, and that's if you can properly appeal a denial. Once you submit a claim, it usually takes up to two weeks for it to hit a denied status. Now that you've already lost two weeks, you'll need even more time to manage and appeal a denial, adding weeks or even months onto reimbursement.


Like many healthcare organizations, your team may find itself buried in so many other regulatory and administrative tasks that it doesn't have time to work denials. But this means you're leaving significant cash on the table. What can you do to alleviate this problem and get the payment you deserve?

Be proactive, not reactive.

The truth is, most denials are preventable. Take these steps to reduce denials:

  1. Train your staff, especially in proper coding and documentation.
  2. Properly verify insurance coverage.
  3. Understand your payers.
  4. Use technology to track and analyze.
Denials will  happen. What do you do then?  

Unfortunately, no matter how hard you try to prevent denials, they're a fact of life. Keeping a close eye on denials and how they're impacting your operational and organizational performance so you can intervene at the right time is paramount for positive cash flow.


What would it mean to your business to have a real-time solution that alerts you to denials and other reimbursement issues when they happen? We're willing to bet it would mean more efficiencies, less stress for your team and better financial health.

When it's time to appeal a denial, you don't want to get bogged down in the manual steps it takes to manage the tedious appeals process. Why let manual processes stifle cash flow when you don't have to? 

With eSolutions' Audits and Denials, your organization gets an innovative, comprehensive and intuitive solution to all your denial management challenges. Audits and Denials offers performance insights that will help you pinpoint denials, improve cash flow and maximize organizational performance by tracking, measuring and managing key financial and operational measures.

manage-denials3With Audits and Denials' workflow automation, your team can rework and resubmit claims effectively, optimizing all follow-up activities in one spot. It manages your appeals at every stage with all your payers, enhances staff communication and integrates with your other systems. It even lets you assign custom work queues to unlimited users.

Knowledge is power, and eSolutions delivers clear, easy-to-read analysis and real-time insights on appeal status, remittance detail, staff productivity, dollars at risk, and more. You can even compare how your organization stacks up against its peers by specialty at the state and national levels.

No matter what your denials management process looks like, it ultimately should lead to:

  • Increased efficiencies and performance
  • Maximized cash flow
  • Improved inter-departmental communication
  • Reduced denied and rejected claims

Whether you're a large healthcare organization or a one-provider office, you can prevent and manage denials like a pro! Click the button below to see how.


Topics: Audits, Denial Management, Business Intelligence, Workflow and Productivity