Bridging The Expertise Gap In Denial Management

Did you know which revenue cycle tasks require the most expertise in today's healthcare world? It’s none other than claims denial management, which poses a major challenge for many practices! A recent survey by AKASA and the Healthcare Financial Management Association found that nearly 80% of healthcare leaders considered claim denial management as one of the most demanding revenue cycle tasks. This isn’t surprising, as managing claim denials has just gotten even harder for practices, especially with ongoing staffing shortages and increased resignation rates. In this blog post we’ll discuss why denial management experts are crucial and offer practical solutions for healthcare providers to fill this gap.

Why Denial Management Matters The Most

Denial management has always been critical in maintaining a steady cash flow and providing quality patient care. But its importance has grown even more after the COVID-19 pandemic. With denial rates on the rise - 17% of in-network claims and up to 80% for some insurers - medical practices are facing increasing financial and operational pressure. A denied claim means extra cost to rework, rectify and resubmit the claim, which literally drains resources and slows down the reimbursement cycle, negatively affecting the practice’s cash flow. These added costs and administrative hassles can disrupt operational efficiency and hinder the practice's ability to smooth effective patient care.

Impact On Patient Care

The implications of claims denials can go beyond financial setbacks – they can impact patient care in many ways. Patients may receive surprise bills, which can frustrate them and strain their relationship with providers. At times, these out-of-pocket costs can be so high that patients skip necessary treatments. Additionally, denials pull healthcare staff away from patient care activities, as they become involved in fixing coding errors or providing additional documentation. In some cases, if the patient's treatment requires insurance approval and the claim is denied, it can delay care and also lead to adverse health outcomes.

Why More Experts Are Needed

A shortage of skilled denial experts makes the problem of increasing claim denials still worse. Managing claim denials effectively calls for specialized knowledge of evolving regulations, coding, and insurance policies. Without adequate experts to manage the denial process, the administrative burden of handling claims denials increases. This ultimately paves the way for rising operational costs and diminished patient care quality. With the healthcare system already stretched thin, the shortage of experts creates inefficiencies that impact practices’ bottom line and care quality. Medical practices should look for practical ways to fill this expertise gap and make handling of claims denials smoother.

Ways To Address This Expertise Gap

• Invest in regular staff training. Conduct regular workshops and offer certification programs to keep them updated on best practices and changes in regulations.
• Hire denial management experts who specialize in handling and reducing claim denials. Their expertise helps in faster and more effective resolution of claims.
• Do not hesitate to hire fresh graduates with no experience. Remember, with the right training and guidance they can soon become invaluable assets.
• Improve the denial process by automating tasks with advanced software. Use AI to spot patterns, predict issues, and prevent them.
• Turn to staffing outsourcing services. They bring specialized skills and tools, freeing up your team to focus on core tasks and reducing your workload.

Conclusion

Filling the gap in claim denial management expertise is no easy task. However, it is something that’s crucial for ensuring financial stability and providing the best possible care. By investing in staff training, hiring experts, automating processes, and partnering with staffing services, you can help tackle these issues head-on. Staffing Angels offers expert denial management specialists with a deep knowledge of industry trends and payer guidelines, ensuring your denials are resolved effectively. Don’t let claims denials disrupt your workflow. Let our denial management specialists step in to fill the expertise gap and ensure your practice runs smoothly!