Imagine a scenario where $150,000 in claims were denied in the first quarter of the year. However, through a thorough examination of the data in just three reports, your team is able to implement additional training for your team, review and adjust documentation for certain payers, and adjust the coding on specific services. With these issues quickly addressed, your Q2 concludes with appropriate reimbursement, saving hundreds of thousands of dollars.
It’s no secret that effective denial management helps recover appropriate reimbursement. Still, frequently, we find that providers need help identifying where to start their claims review reports to understand where, when, and why certain issues occur.
There are numerous opportunities for reducing time to money throughout the claim process, and there are several reports that can help you identify where to start. Most of these are readily available resources to the revenue cycle staff and should help you move forward with your denial management processes.
1. Aged Trial Balance (ATB)
Report Goal: Identifying trends in claim aging, including reasons for denials, services denied, and payers that denied claims.
A detailed analysis of the Aged Trial Balance (ATB) will help you identify specific data points and demographics on the aging of claims. This report contains a significant amount of data and, while it may seem daunting to parse through this level of information, it will provide you with ample detail relevant to the aging of claims. For example, using the data in the ATB reports, you should be able to identify the top reasons for denials, common services denied, and common payers that deny claims. In addition, identifying the data trends helps you see a more comprehensive view of what warrants additional training, further communication with provider liaisons at various payers, and/or updated hospital processes and protocols.
2. Insurance Aging
Report Goal: Identifying outstanding payer balances.
An insurance aging report measuring outcomes by payer is a similar report to the ATB, but here you can hone in on denial and appeal data by payer. This information is incredibly useful in determining data trends by payer, which enables customization of your approach to denial management by payer. It is imperative that the staff members responsible for submitting clean claims and ensuring timely payments are aware of the details of payer contracts. Proper documentation and coding of services are essential in ensuring that appropriate reimbursement for services are rendered.
For example, some payer agreements require claims to be submitted with an alternative diagnosis-related group (DRG) rather than the typical Medicare severity DRG. This requirement helps provide guidance to prevent future denials by allowing for claims team education on trends specific to a particular payer, existing contracts with those payers, industry guidelines, the intersection between payer contracts and those guidelines, as well as common best practices.
3. Employee Productivity Report
Report Goal: Identifying an individual’s recovery rate over time.
The Employee Productivity Report is an important indicator of an individual employee’s success. This report provides a wealth of information, from the age of accounts to specific individuals’ productivity, as well as helps you understand what that individual’s recovery rate over a certain period was, what the return on investment (ROI) was (i.e., “hit rate”), and more. In addition, the Employee Productivity Report can provide insight into where additional training might be necessary, and guidance on progress made afterward.
These three reports provide a great starting point for most providers in making sense of denial management data. However, it is essential to understand that organizations may need additional reports that tackle different topics, especially those that delve into nuances specific to their needs. These reports should evolve as you address problems with denial management and revenue loss.
Advent Health Partners can help you determine what specialized reports your organization needs and how to use them with our Optics business intelligence dashboards. Comprehensive denial management analytics combines claims and denial data with Advent’s clinical and technological expertise to deliver real-time, actionable dashboards. To see how Optics can help you streamline your data reporting trends, and identify areas of improvement, schedule a 20-minute Optics consultation with our team to learn more.