What is denial management?
Hospital admissions require authorization from insurance companies for the appropriate level of care and length of stay for patients, and a denial occurs – either concurrently or retrospectively – when the payer does not authorize the care provided. Denials occur for a variety of reasons – whether a coding error, disagreement on the level of care or missing data – and may involve both clinical and non-clinical hospital staff. A peer-to-peer evaluation may be conducted between physicians at the hospital and payer to overturn a denial, and an official appeal is a rebuttal of the payer’s decision.
Market problem
Both commercial and public payers deny approximately one in 10 submitted claims, costing health systems up to 2% of net patient revenue, and placing an increased burden on hospitals to respond to denials and minimize the loss of revenue. Denial management teams are growing, with specialized roles to work through an increasing amount of cases, leading to increased needs for handoffs to successfully research and appeal denials. There is high demand to track these cases, but there has been no product to fully address the demand.
How can CarePort help?
CarePort’s offering, Denial Management – which lives within the CarePort Care Management product – was built with daily workflow challenges in mind. The tool provides users with the following capabilities, among many others:
- Flexible workflow allowing for customizable documentation, management and tracking of concurrent denials, self-denials and downgrades
- Integration with EMR and revenue cycle solutions to connect disparate departments and streamline communications
- Reduce retrospective denials with more efficient management of concurrent denials, and operational efficiency for appealing denials
- Reporting that tracks key metrics to identify opportunities for interventions to reduce high denial rates and improve team productivity
Unlike other solutions on the market, CarePort provides not only a one-stop solution for denial management, but an entire care management solution – including a powerful referral tool – all in one offering.
Contact CarePort for more information regarding Denial Management, CarePort’s denials and appeals offering.
