Six Best Practices for a Hybrid Approach to Denials Management
Date Posted: Friday,
January 01, 1999
In the final installment of our three-part series on redefining the return on investment (ROI) in denials management and driving financial success , we explore best practices essential for implementing a hybrid approach that combines global resources, intelligent automation, and advanced analytics to create a cost-effective and scalable solution for managing denials . Six key strategies can enable healthcare organizations to manage an approach with in-house and global support teams to turn denials into an opportunity for improved operational efficiency and profitability.
- Strategic Planning: Collaboration between onshore and global support teams begins with a well-defined plan. Establishing clear goals with defined key performance indicators (KPIs) and service level agreements (SLAs), inventory assignments, and responsibilities ensures a balanced workload and enhances workflow management, leading to optimized operations and a distinct governance structure between partners.
- Equitable Treatment: Fostering a “team without borders” mentality is crucial. By reinforcing collaboration across geographic locations, organizations can tackle challenges collectively and share insights, which streamlines the path to achieving common goals.
- Clear and Effective Communication: Open communication channels facilitate effective management and alignment among team members. Moving from transactional exchanges to meaningful dialogues nurtures a culture of openness that integrates the entire team.
- Building Trust: Establishing partnerships grounded in mutual respect enhances operational efficiency. Trust is vital for a culture of collaboration that is necessary for identifying and overcoming challenges.
- Continuous Shared Learning: The ability to adapt and learn from challenges strengthens the hybrid model. Organizations should prioritize feedback and collaborative learning as a means to maximize operational efficiencies and team performance.
- Leverage Technology: Advanced AI platforms offer healthcare organizations enhanced inventory management and accounts receivable resolution. By streamlining task assignments between onshore and global support partners, these technologies create effective workflows and bolster cooperative efforts towards shared organizational goals.
Access to real-time reporting keeps healthcare organizations informed on trends and enables adjustments in denial management practices as needed. By proactively monitoring denials and identifying root causes through the integration of AI and analytics, healthcare organizations can implement critical process improvements based on real-time data that inform key performance indicators. Additionally, a proactive approach that utilizes machine learning (ML) technology to learn from historical patterns allows financial leaders to make data-driven decisions, particularly when targeting denials with a higher likelihood of successful appeal.
Technology in Action
A Wisconsin-based regional health system faced persistent challenges in tracking payer denial behavior. By deploying AI-driven predictive denial analytics, the organization was able to address denials before claim submission, achieving a remarkable 40% improvement in its overturn dollar rate just a month following implementation. Additionally, the health system achieved a 5:1 ROI over the first year, with its 4 percent denial dollar overturn rate improvement resulting in incremental overturn dollars of $725,000.
Additionally, the strategic adoption of actionable analytics enabled the organization to pinpoint areas for denial prevention. For example, identifying patterns where patients were denied authorization multiple times allowed the organization to address the existing issues and proactively plan and train staff on these requirements for future denial scenarios.
Download our comprehensive white paper, "Redefining ROI in Denials Management," to gain deeper insights into these best practices and the innovative solutions and technologies that can help mitigate denials, improve financial performance, and drive operational efficiencies.
Matthew Bridge
As senior vice president of RCM services at AGS Health, Matt oversees strategic growth initiatives for the company's Patient Access and Patient Financial Services business units. He possesses more than 15 years of experience in professional and managed services with expertise throughout the revenue cycle continuum. Matt's career has provided him with broad experiences covering diverse provider settings and a deep understanding of the challenges facing customers of all provider types. He is passionate about mentoring and coaching others as they pursue their career journeys in revenue cycle and healthcare business management. Matt possesses a bachelor's degree in business administration and management from Curry College in Milton, MA.
Ryan Chapin
As Executive Director of Strategic Solutions at AGS Health, Ryan assists with strategic growth initiatives for the company's Patient Access and Patient Financial Services business units. He possesses more than 8 years of experience in professional and managed services with expertise in delivering clients transformational engagements focused on improving financial and operational metrics, and the patient experience. Leveraging his background in Revenue Cycle Consulting, Ryan brings a true consultative approach to how AGS conducts business with our customers.
www.agshealth.com/
