Putting the 'Management' in Denials Management

 This is the second and final part of a series on denials management from Prosource. The first part, “The Three ‘Rs’ of Denials Management,” can be read here. 

There is never a moment you can put denials management on cruise control.

The continuously changing landscape means you can never relax your guard. In the world of denials management, talent and technology are king.

All denials are not equal, and when responding to denials you have to carefully manage how you assign your staff to address them. If your organization distributes its caseload by alpha split, arrival date, or other random factor, you are missing a giant opportunity.

Because denials can be based on widely divergent factors ranging from simple to complex, your team needs to similarly reflect that. We’ve encountered many organizations who believe a biller is a biller is a biller. It’s simply not true. Not all billers are equal. It is the rare healthcare provider who has a full slate of Grade A billers; most have mixed skill and experience levels.

At ProSource, we have some of the most skilled billers in the industry, but some are more skilled and experienced then others. The way we manage denials for our clients is that after we conduct a root cause analysis, we distribute them to the biller best qualified to produce the best result in the least amount of time.

For example, a denial based on registration error related to patient eligibility, does not require the level of skill to resolve than a denial based on a coding error or medical record error. If a payor denies a claim because a service provided was not medically necessary, you want your most skilled biller to work on that account.

Sorting your worklog of denials and distributing them to the appropriate biller is where the “management” of denials management comes into play. What you don’t want is for that process to consume as many internal resources as the staff you require to resolve the denials.

This is an area where technology comes into play. The better able your organization is to programmatically distribute the workload to the most effective resources the lower your overall cost.

At ProSource, we built a proprietary denials inventory management system that sorts and distributes the denials caseload based on a series of business rules that we have developed as a result of our experience over the last 15 years. These business rules, incidentally, are always changing as the landscape of denials management continues to evolve. They are also unique to region and client.

In addition to sorting denials based on type and complexity, our inventory management system sorts based on priority, timeliness, and dollar value, so that our biller resources are engaged on the patient accounts that result in the highest return for the least possible cost.

Shanna Rogers is a supervisor with ProSource Billing, Inc., a part of the Array Services Group family of companies. Shanna has 13 years of Revenue Cycle experience working with many types of organizations. She has been with ProSource Billing for the last 10 years contributing to and managing projects.