Revenue cycle management (RCM) can go off the tracks easily enough with just a few missteps in processes and operations. When RCM mistakes are made it typically results in slow or no payments from payers and patients. Neither of which bode well for providers. If the mistakes become a chronic occurrence, the medical practice can miss out on receiving hundreds of thousands in revenue.
While there are several ways a practice’s accounts receivable can be impeded by informal or out-of-date income processes, denials are among those most often attributed to slow payment. The average office experiences a 12% denial rate and most of those denials aren’t appealed. Over time, unworked denials often find their way off the accounts receivable record, which makes it appear as though the practice is doing better financially than it actually is. It’s crucial that working denials are part of a formal process to ensure the payments or non-payments are accounted for as part of the practice’s overall financial status. At the practice level, denied claims may not always appear to have a significant financial consequence, but the macro level tells an altogether different story. Whether the practice bills Medicare, Medicaid or a commercial insurer, there’s an extremely high likelihood that a fair number of claims will be denied, amounting to at least, but likely far more than, $11 billion in revenue that healthcare providers may never collect.
When primary care providers attempt to collect, it takes nearly $100,000 each year in billing and insurance specialists just to get paid for the visits that occur during any 12-month timeframe. Because providers are running a negative balance just to collect, it’s imperative all denials be worked quickly, efficiently and with accuracy to ensure payment to make up for and, hopefully, surpass this financial deficit.
Don’t let inefficiencies from denials choke your practice’s revenue. TriZetto Provider Solutions offers a cost-effective way to discover and appeal denied revenue. Plug your numbers into our custom ROI Calculator and see how much more you could save with our Denials Management solutions.
For more information about Trizetto, please contact your Client Insights Manager, John Webb, at 1-800-624-8832.