Did you know that three percent of net revenue loss is caused by denials?
With the profound changes in healthcare this year, how can providers stay ahead of their revenue cycle while managing the day-to-day needs of patients? Tricia Hisserich, Product Manager at TriZetto Provider Solutions (TPS), shares her tips and tricks that can help providers seamlessly manage denials and retain revenue.
Q: What’s the state of the industry?
A: As we all know, our industry has been one of the most effected industries during 2020 and it has seen changes that no one could have predicted. What we’re hearing from our clients and industry connections is that denials are top of mind, more so than ever before. They’ve always been a constant, but the need to prevent them and manage them has only been magnified by COVID-19.
Q. Why are denials so important nowadays?
A. Less patients coming through the door means less revenue, so every dollar is critical. When a provider is seeing denials, the odds of retaining that dollar are threatened. More than 65 percent of denied claims left unresolved, so revenue loss can quickly add up.
Q: What’s spurring this need?
A: The economy and the pandemic are the major catalysts, but the switch to high deductible health plans also plays a part. Gaining every dollar from the payer matters more than ever because there’s no guarantee you’ll collect what you earned.
Q: What can providers do to adapt?
A: Many of our clients are independent medical practitioners, but also small business owners running a medical office. They’re trying to survive and manage their business amongst the chaos, like many others. They need to be able to pivot and adapt, and they need the right resources to do so. I would recommend they assess their strengths and weaknesses so they can implement the appropriate changes and get assistance.
Q: What steps would you suggest providers take?
A: Mitigating denials up front can see significant improvements. Providers can no longer sit back and ignore your revenue cycle. It may have run smoothly on its own in the past, but times have changed. A practice needs to have an in depth view of all processes and procedures.
Q: How can TPS help?
A: We help providers manage it all, the full process. Our tools give insight into backend process that are often overlooked in a busy office. For example, no one has time to go through every payer website. We tackle tasks like that.
Q: What’s coming up?
A: We’re always trying to innovate to offer clients the latest products and technology. We are updating our denials and contract management solutions to include two new capabilities that make it easier to manage denials and prevent lost revenue. Users will see new interactive dashboards and a new work queues feature for a better way to identify and recover denials and underpayments.
It’s all about driving efficiency and making processes more streamlined so providers can devote their energy to caring for patients.