Working denials in radiation oncology used to be a matter of sorting and looking for the Pareto results (i.e. 80% of your denial volume comes from 20% of your claims). Practices that were trying to establish priorities in denial management would evaluate denials by dollars and by volume. Inevitably, certain denials by procedure or by payer would be identified, and the group would work on resolving those denials. The overall process improvement concept would be that as the denial management group made progress they could work their way through to lower value claims and volumes. The process involved constantly sorting through denials in new ways trying to identify the greatest opportunities.
One problem with this approach is that denials are only being evaluated retrospectively and teams generally have limited capability to focus on more than a few denial codes at a time. Meanwhile, denial trends can change quickly with changes in payer policies and other factors. Further, the approach often fails to catch denials that don’t fit into the analysis but may be high dollar and easy to fix. With all trends in healthcare pointing toward increase payer scrutiny and involvement, radiation oncology practices and radiation oncology billing services need to consider whether what worked in the past will continue to be effective in the future. A report from HIMSS Analytics estimates that 66% of those providers currently without a denial management solution will be looking for one over the next 6 months.
With improvements in data analytics and machine learning it’s possible to lead your team with data-driven insights. Modern platforms offer advanced analytics that can identify denial management opportunities in real time and embedded workflow tools to help your team stay on top of all business-critical metrics and better predict financial results. The right platform can consolidate all machine learning from your denials data into one single platform and continuously render the workflow for the optimal denial management efforts. These tools can supplement existing revenue cycle management operations with comprehensive denial management workflow and early out solutions for patient collections.
Although a knowledgeable and experienced denial management staff will always be an absolute necessity, the human brain has a limited ability to recognize patterns in the large volumes of claims data inherent in most radiation oncology practices. A dedicated, systematic approach to addressing denials will help any practice or radiation oncology billing service, but an analytic solution where actionable claims are automatically routed to the appropriate teams to be worked is the new standard in denial management. Ideally these solutions can be configured to enable radiation oncology billing services to fix issues before they result in denials.
Contact New Bedford today to learn more about how we’re using the latest technology coupled with experienced staff to realize optimum results in your revenue cycle.