Now that you’ve read about the top five types of claims denials and the top two KPIs to keep a watchful eye on, SSI experts Lori Brocato and Kaylee House share key strategies to help you and your organization make improvements in denials management.
Eligibility related denials often result in a hard denial or one where you will not likely be paid and these include those related to coordination of benefits, plan coverage, incorrect plan code entry, maximum benefit exceeded, inactive coverage, or even member not found. These types of denials often stem from either the information not being obtained from the patient during preregistration or when they present at registration.
One of the most overlooked, but arguably one of the most important aspects of the hospital experience is patient access. Patient access encompasses the front-end registration process and all of its supporting financial dealings with providers, patients, and payers