Reduce Denials for Cost Savings
Targeted Denial Prevention Reduces Rework and Creates SavingsIndustry standards suggest that the average cost to rework a denied claim is at least $25. This means that even a 1% reduction in your denial rate can have a huge positive impact on your organization. The CPSC provides members with comparative data reports that can help your organization identify successful paths to denial prevention.
Do the Math: The Impact of Reducing Denied Claims
3% reduction in number of claims requiring rework
Cost to rework each claim
The department of medicine at a certain clinical practice plan generated approximately 300,000 claims per year, averaging a 16% denial rate. After one year of targeted denials management based on CPSC reports, that denial rate was reduced to 13%. This decreased the number of claims requiring rework and saved the department $225,000.
In addition to the enormous cost savings from reduced rework, the benefits of targeted denials prevention and management include:
- Improved cash flow for your organization
- Increased revenue from collections on previously unpaid or underpaid claims
- Data to make discussions with payers easier (administrative simplification opportunities)
Which CPSC Reports Can Help My Group Reduce Denials?
The RCS Denials Module supports targeted denial prevention and management through five core reports that are easy to generate and understand:
- Denial Rates Analysis
- Denial Reasons Analysis
- Denial Rates Analysis by Location
- Denial Reasons Analysis by Location
- Denials Action Report
The reports provide comparative data on denial rates and denied claims that are subsequently paid by department, specialty or provider. Payer and CPT code data is also included. Additionally, the CPSC produces a quarterly dashboard report to measure performance against the CPSC benchmark at the median and the 75th percentile.
Learning this information and comparing it to similar groups in the CPSC helps you illuminate a clear path forward toward reducing denials.
Understand Where Your Denials Are Coming From
For many groups, pinpointing specific components of front-end processes for denial tracking and follow-up can be difficult. Focusing on just two categories of denial — front-end rejections and clinical rejections — allows departments to pinpoint exactly where in the revenue cycle these denials are occurring.
From there, it’s easy to properly allocate resources or adjust your processes to reduce denials and improve your overall collections. CPSC members find the RCS reports especially helpful for tracking denial types and reasons.