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.
Stopping denials from happening altogether, on the front end of your revenue cycle, is a much better strategy than managing denials on the back end. With an industry average denial rate of 5-10% and a clean claim rate of 90%, SSI provides industry insights about these types of denials as well as denial prevention strategies to help you improve.
The ability to use Direct Data Entry (DDE) into Medicare Fiscal Intermediary Shared System (FISS) has been around for decades and is still widely used today. Even with the proliferation of Electronic Data Interchange (EDI) transactions that can be used instead, users still use DDE to manually enter, correct, adjust, or cancel Medicare transactions in FISS.
The SSI Group, a leader in financial performance solutions for providers and payers, announced today a partnership with RCxRules, a leading provider of automated billing solutions for healthcare organizations’ population health and revenue cycle operations.