DENIAL MANAGEMENT: Denials Analysis System

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Denial Management

Identify and account for all payer denials and target problem areas that affect the bottom line to assure collection of all receivables due from payers.

Automates and accelerates the identification and resolution of claim and service-level denials
Permits analysis of payer adjustment codes on remittance advices and processing of denials according to client-driven parameters
Identifies automatically denial reason and routes claims to individuals who can research, correct and re-file claims
Integrates seamlessly with existing patient accounting systems and assures collection of all receivables due from payers
Generates reports for measuring and managing staff or department performance:

Determines patterns of common errors from upstream departments
Identifies recurring problems with master files, such as Insurance and chargemaster files
Quantifies upstream revenue opportunities
Reports on active workload management
Reviews productivity and financial analysis of incoming denials

Supplies timely information about payer reimbursements for appeals and rebilling as well as online denial reports in multiple formats, so managers can perform root cause analysis on denied claims:

Percentage of claims denied
Most common types of denials
Payers denied most frequently
Net effect of denials on cash flow

Improve your
Operating Margins

MedAssets improves
and sustains
operating margins
by 1.5% to 5%.

John Peter Smith Health Network

John Peter Smith Health Network’s clean claims rate jumps to 95%, A/R day performance rate improves by 27 days in the first 12 months, and ultimately cash collections increased from $93 million to $180 million in four years.