Denied claims cost the healthcare industry billions of dollars every year, leading to increased administrative burden, delayed payments, and reduced cash flow. Tackling denials isn’t just about resolving these rejections. You need to build a denial prevention strategy that protects revenue and reduces unnecessary overhead.
Investing in proactive denial prevention leads to measurable ROI through faster reimbursements and reduced write-offs. Learn how to prevent claim denials with modern processes and cutting-edge solutions, such as Rivet.
At Rivet, we define a denial as:
In other words, the claim line is effectively dead on arrival. It won’t bring any revenue to your practice unless you rework it or win an appeal.
Here is a breakdown of the most common causes of denials by percentage:
Non-response or delinquent claims are of particular concern, as these are considered soft denials. The insurance company may just forget about the claim. If you forget, too, your organization won’t get paid.
Claim denial prevention strategies can be grouped into three categories, which are as follows:
Strong denial prevention begins before the patient even walks through the door. Step one involves performing patient registration and insurance verification in real-time. With Rivet, you can perform eligibility checks before the patient’s visit and provide them with an accurate cost estimate. This reduces the risk of surprise bills and helps you capture more revenue.
Your team also needs to collect and verify patient information. Simply asking, “What is your current address?” rather than, “Are you still living in the same place?” can help your staff find and fix more errors.
Prior authorization and pre-certification are also critical to denial prevention. Make sure you are filing authorization requests in a timely manner and tracking the status of each request. Once appointments are booked, send patients confirmation messages and reminders.
Accurate coding represents the next critical element of denial prevention. You need to:
Your team also needs to create strong clinical documentation to promote strategic and accurate coding. Use specific language that clearly supports the medical necessity of the services you provided. Ensure that the documentation answers the questions “Why did the patient come in?” and “Why did the provider choose this treatment?”
Be consistent with diagnosis pointers, as missing or incorrect use can lead to denials.
When it comes to how to prevent claim denials, here is where all of your hard work comes together. When submitting claims, make sure that they are clean and easy to process. Electronic claims submission reduces the risk of errors or delays. You can also implement a “Bill Scrubber” to check for errors before submission. Leading solutions can check for custom edits, NUBC, MUE, and CCI. They can also perform LCD/NCD checks.
If a claim is denied or placed on hold, follow up on it in a timely manner. Track denials, analyze each claim, and focus your appeals efforts on the claims with the greatest likelihood of being overturned. You don’t want to waste time or resources on low-value claims that probably won’t get passed through.
The revenue cycle is more complex than ever, which is why having the right tools is essential. Revenue cycle management software centralizes key processes like eligibility checks and claim status tracking. Top platforms also include denial dashboards and reporting tools, enabling you to identify recurring issues by payer, provider, or CPT code.
A solution with automation capabilities saves time and prevents human errors. The goal is to reduce the burden on your team while expediting RCM processes.
Rivet offers solutions tailored to these needs, including Claim Resolution. Claim Resolution is a strong healthcare denials management system that will help your team work denials smarter and recapture more revenue.
Learn more about Claim Resolution, Rivet denial management software.
Empowering your team with the right tools will promote denial prevention and better cash flow. However, human error remains one of the biggest contributors to preventable denials. Training your team and teaching them to work together is the catalyst for efficient denial prevention at scale. Here are a few tips:
Investing in your staff’s knowledge pays off in fewer denials and fewer appeals. More importantly, you’ll win more appeals and strengthen cash flow.
You can’t improve your denial rates unless you are watching the right data. Use KPIs to track the ROI of your denial prevention efforts, such as the following:
With tools like Rivet, you can track these metrics and visualize them into digestible reports that offer actionable insights.
Denials prevention is one of the most cost-effective ways to improve your organization’s revenue cycle performance. It boosts cash flow and reduces labor costs while increasing payer accountability.
Rivet offers the tools and insights you need to prevent denials before they happen and recover revenue when they do. Schedule a demo with Rivet.
