DESCRIPTION:
An average of 18 percent of health claims are routinely denied by managed care plans, according to providers participating in a survey by The Managed Care Information Center (MCIC).
That's
why "How to Optimize Your Organization's Cash Flow by Effective Denials Management" was organized. The transcript of this special teleconference, featuring two highly respected leaders in
the field, focused on submiting approvable claims and how to successfully appeal denial of a claim.
"50 percent of denied claims do not get followed up. They (health plans) bank on this," said a manager of consulting services for a clearinghouse.
"Unfortunately providers refuse to learn the basics of how to avoid denials and then take no action to recover through appeals," said the CEO of a physician organization. "Providers that enforce their rights have fewer denials than those that accept them."
A physician organization said the problem could be helped with education. "Most denials are self-inflicted."
Among the actions taken by payors to make the claims process more efficient are provider and member educational efforts, increasing CCI edits and quality checks.
"The re-work associated with re-adjudicating claims to recover monies owed under the contract is labor intensive and time consuming not only for hospital staff but health plan staff." said a medical center director of managed care operations.
If you have ever had a claim denied, read the transcripit of the program that could mean hundreds of thousands of dollars for your organization.
TOPICS COVERED:
- Importance of knowing your 'denial rate' and your 'recovery rate',
- Current claim system,
- Edits – the different types of edits (field, utilization, compliance) that cause denials, and new types of edits being added
- Importance of appealing denials.
- Real life experience in dealing with claim denials
Plus a live Question and Answer Session
SPEAKER PANEL:
- Barbara Aubry, RN, CPC, CHCQM, Utilization Specialist for Holy Name Hospital.
- Bill Phillips, FACMC, CHC, Vice President & CRO of Revenue Strategies Inc.
WHO WILL BENEFIT FROM THIS TRANSCRIPT:
Hospitals, Health Systems, hospices, home health agencies, healthcare providers, disease management companies, CEOs, CFOs, hospital managers, medical directors, healthcare management, TPAs, network managers, physician practice management company executives, medical management directors, PHO and IPA leadership, financial analysts, implementer consultants, account services and administration executives, administration, billing and accounting, controllers, patient accounts managers.
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