Infographic: Get Out of the Denial Danger Zone
Positioning Your Organization to Win at Denial Management
August 17, 2022
With claim denials on the rise and nearing the “danger zone” at many hospitals, it’s important to leverage all the tools available to help you identify, manage, and ultimately prevent as many denials as possible. The infographic below explores the impact and cost of denials, along with a smarter strategy for how to win at denial management.
Beware of the ‘Denials Danger Zone’: Hospital Claim Denial Rates have Hit New Highs.
- 89% of hospitals and health systems have experienced an increase in denials over the past 3 years. 51% say the increase has been significant.1
- U.S. hospitals are facing average denials rates between 6% and 13%, which hospital leaders say is nearing the “danger zone.”2
The High Cost of Denials
- 9% of hospital claims are denied, which equates to roughly $262,000,000,000 in denied claims nationwide.3
- Up to 65% of denied claims never get worked, resulting in a 3 percent loss of revenue.4
- The Good News: 2/3 of denials are recoverable!5
A Smarter Denials Management Strategies is a Necessity
A Path Forward: SSI Solutions (Claims Reporting and Analytics, Denial Management, Audit Management)
As denials become an even bigger pain point for healthcare organizations and leaders, a well-orchestrated denial management strategy powered by the right technology and processes is becoming a must-have if you want to better manage denials and appeals – and stop revenue leaks.
SSI CLAIMS REPORTING: Actionable insights to minimize denials.
Utilizing machine learning and intelligent automation, SSI Claims Analytics provides access to real-time revenue cycle data along with the ability to transform the data into the insight necessary to significantly simplify the denial management process. Pre-loaded, interactive dashboards allow you to see denials by payer (aggregate or at the individual level) and even by the patient. Additional information including the denial reason code and the Electronic Remittance Advice (ERA “remit”) arms you with the detailed level of data you need to fix denials. With SSI, you can develop a big-picture approach to resolving denial challenges while simultaneously honing in on the most critical areas for improvement.
SSI DENIAL MANAGEMENT: Dramatically diminish the volume and financial burden of denied claims.
Our powerful, easy-to-use platform simplifies denial management from the start and helps your revenue cycle team take a proactive approach to working unpaid claims and managing the recovery process. SSI Denial Management allows users to: easily identify and resolve denials, uncover hidden denial trends, monitor the impact of denied claims, determine and correct the root cause of denials, quickly submit appeals, and track custom key performance indicators (KPIs).
Exception-based workflows and custom work queues automate and simplify the follow-up process allowing staff to easily prioritize, route, and manage denied claims and underpayments. With powerful reporting capabilities and activities based on user or role, organizations can appropriately route these denials to the appropriate workforce based on expertise.
SSI AUDIT MANAGEMENT: Gain insight into the root cause of denials and maximize appeal recoveries.
Integrated with all major health information systems, SSI’s audit management tool, Audit Director, enables providers to break down denial silos and improve collaboration across your organization. With this solution, SSI can help you and your revenue cycle team write a smooth workflow for accepting and tracking the complete audit process. You will be able to move audit requests electronically to any department, scan, and attach any supporting documents. Users can gain insight into the root cause of denials as well as benefit from the appeals management tool that provides the ability to store payer-specific appeal letters and streamlines the appeal package process for tracking wins and losses – all to better help you capture and retain crucial revenue.
As more payers allow you to file appeals online or at least start the process with online forms, SSI makes it easier for you by automating those that can be submitted online/applicable ones. This solution can even electronically submit the appeal with supporting documentation where attachments are required.
3,4 HFMA, 2021, https://www.hfma.org/topics/hfm/2018/september/61778.html
5“An ounce of prevention pays off: 90% of denials are preventable.” The Advisory Board Company, Dec. 11, 2014.