Closed Loop Denial Prevention Process

In healthcare an ounce of prevention is often better than a pound of cure; this is certainly the case when it comes to managing your revenue cycle. Identifying and preventing denied claims before they ever happen is critical to a healthy bottom line. A closed loop denial prevention process is a continually adjusting process that combats the ever-changing health insurance landscape to prevent denied claims.

Beats the heck out of sticky notes. 

Denied claims are costly for practices, but when you consider hospital charges, denials can become even more expensive and more difficult to prevent. Reimbursement for inpatient hospital care is higher than an established patient office visit, thus the denials are more costly. Furthermore, in the hospital setting, doctors are responsible for completely documenting each patient’s procedure and diagnosis codes and ensuring those charges make it back to the billing department.

Doctors Are Not Coders

Doctors are not, nor should they be, coders; they employ billing professionals to handle their coding and revenue cycle management. Even with the most impressive billing team supporting a doctor, it is important to remember the coding process starts in the hands of the doctor. With this in mind, what is your billing team doing to ensure that claims originated in the hands of a doctor are coded correctly when they are submitted to insurance payers? What are you doing to limit denied claims?

Billing teams are responsible for taking doctors’ raw charge data and making sure claims are coded correctly and completely with modifiers, units, and in accordance to that patient’s particular payer regulations. Most insurers have a unique set of rules and regulations regarding claims which they constantly modify. This makes it nearly impossible to keep up with who requires what and when. Realizing marginal improvement in denial prevention requires the ability for multiple employees to recognize, adapt and recall thousands of constantly moving data points with prodigious precision.  

What would the impact be if you could download the knowledge of your best billing/RCM employee and replicate it with flawless execution in all of your employees?

Prevent Denials with White Plume

AccelaMOBILE, alongside AccelaSMART, helps doctors quickly capture charges on the front end and ensures the billing team submits claims in accordance with ALL updated payer rules and regulations. With AccelaMOBILE, doctors and staff use their device of choice (mobile devices, tablets, laptops, and desktops) to manage, capture and review hospital, surgery center, nursing home and other out of office visits. As soon as doctors enter charges, the billing team can immediately and quickly begin reviewing and processing these charges. AccelaSMART is a comprehensive rules-based management and automated workflow engine for code editing, front-end denial prevention, exceptions, variations, change processing and MD/practice-specific preferences.

With AccelaMOBILE and AccelaSMART, your doctor will never have to be a coder.