Differentiating the Exceptional from the Conventional: Using ECM to Improve Claims Denials Management
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(1)Overview: This paper addresses ways healthcare organizations can expand their use of technology beyond electronic health records. According to Healthcare Financial Management ("Six steps to an effective denials management program," September 2005), "Studies have suggested that implementing an effective denials management program can have a more dramatic impact on improving the bottom line than any other single revenue-generation or cost reduction initiative. The consensus is that an effective denials management strategy is crucial to minimizing a healthcare provider’s revenue exposure."
Clearly, it is not enough to merely identify denials and address them on an individual basis. Manual processes simply are not capable of addressing a denial processing strategy on a level that will provide significant returns. Using performance analytics to measure and manage your denials is the best way to implement a universal strategy for recovering revenue for services rendered. Most healthcare organizations lose 3 percent to 7 percent of their revenue to denials (Healthcare Financial Management, "Using technology to improve denials management," August, 2005). A strong strategy coupled with appropriate technology can significantly decrease your losses, create a stronger cash flow for your organization, and improve your overall business performance.
This article specifically addresses how ECM technology can be applied successfully to dramatically increase the efficiency and effectiveness of processing claims denials, resulting in considerable savings for healthcare organizations.
