Advanced Revenue Cycle Analytics: An Overview

Medical billing denied claimsDenied claims are the main source of revenue loss for medical practices. Payers rules have gotten more strict, and every year there is a new set of ICD-10 codes to update. It is easy to have denied claims, and it is costly to resubmit them. However, it is even more costly to ignore them and lose all of that potential revenue. Keeping your denial rate low is crucial to having a healthy revenue cycle.

What steps can you take to decrease those denied claims? Here are just a few that will get you started:

1. Identify the main causes of your denied claims

You can’t solve a problem until you know what the cause is. Take some time to analyze some of the main reasons that your claims get denied. This will be different for every practice. Reasons may include:

  • Patient demographic errors
  • Duplicate claim submission
  • Service not covered
  • Incorrect modifiers
  • Claim not submitted in time

2. Use software to prevent incorrect coding

Many of these problems can be addressed by filtering your claims through a rules-based software. If your claims are stopped for review every time they are missing certain modifiers, or using outdated ICD-10 codes, you can greatly reduce the amount of denied claims. AccelaSMART is a rules-based software that works on an exception-only basis. That means that your coders don’t have to stop and review clean claims. They only review claims with errors. This saves you time and money, while increasing the accuracy of your claims.

3. Use analytics to discover where coders are making changes

Sometimes your coders are making manual changes that prevent claim denials. However, coders are human, and they can make mistakes. Using detailed analytics to discover which coders are making what changes can help you to build out custom rules that will stop your coders every time they need to make the change. You can also find out which coders are working the most efficiently, and they can pass on their skills to the rest of your team.

4. Continue to improve until denial rate is average or below average—between 5 and 10%

Decreasing your denied claims is a continuous process. The rules of the industry are ever-changing. But to have a thriving practice, you must continue to make improvements. Your denial rate can be at 5% or below. Schedule a free revenue cycle analysis and see how we can help your practice reduce denied claims.