Spreadsheets, Templates and Other Practical Resources
Managing and Improving Your Billing and Collections Process
Denied claims mean delayed, and sometimes, lost revenue. HFMAs Denials Management Toolkit, a collection of eight interactive electronic tools, helps you manage your revenue cycle to prevent denied claims and resolve claims faster. Provided by revenue cycle experts, the tools can be used immediately. Just input your own hospitals information for successful results in denials management.
Description of Contents
Denial Management Comparison
This tool can help revenue cycle directors normalize, track, trend, and determine collectibility of claim denials and then zero in on root causes of denials. With this tool, users can define and categorize denial codes, create a denial hierarchy, create a denial database, and analyze data in a denial database and compare the data with key performance indicators.
Claims Denial Tracking Spreadsheet
Claim denials involve time-consuming appeals, increased gross days outstanding, reduced cash flow, and increased allowances for denied claims. Not knowing what claims have been denied and why can mean delayed payment or even lost revenue. This tool helps patient financial services staff keep track of claim denials, the reason for the denials, and the status of the follow-up. Using the spreadsheet, staff is able to address the services and areas responsible for the majority of denials and show management the impact on net income. Specific departments can be targeted for improvement efforts. Monitoring denials will help providers implement operational changes that will enable the hospital to receive payment they are entitled to faster.
Departmental Dashboard
This tool consolidates many of the most important accounts receivable indicators into one report. The report is used to track A/R performance by department and by the organization as a whole. Because several months of data are included, trends can be easily identified.
Denials by Payer Report
This tool identifies, quantifies, and sorts denials by carrier, provider, location, current procedural terminology code, date of service, type of denial, or any other reportable field. The report saves staff time in identifying carrier patterns and supplies meaningful data for performance contract analysis.
Denial Tracking Comparison
This tool enables users to easily identify carrier processing errors in denial reports, providing a more efficient and cost-effective manner of handling claims. The provider can generate a list of claims that may have been denied inappropriately, including detail needed by the carrier to identify the claims, and present the list to the carrier for correction. This tool will help eliminate or reduce labor costs and place the cost of reprocessing the claims in the hands of the carrier.
Expected Payment Reporting
This tool compares actual payments received from payers with contracted fee schedule payments. The provider can present the data to a payer for prompt reprocessing or, if the volume of claims is high, to obtain a settlement to avoid additional cash delays.
Take-Back Pursuit Sheet
Providers can lose revenue when a payer takes back a payment for a service unless the providers carefully monitor accounts. A take-back is an effort by a third-party payer to identify another source of payment for services. When a take-back occurs, the hospital has to not only rebill the claim to another payer, but also inform the patient about the claim status and that the patient may be responsible for payment if the payer does not pay it. This tool enables user to identify and monitor take-backs and measure the hospitals success in recouping payments to reduce the financial impact of take-backs on the organization.
Sample Appeal Letters
Explanations of benefits often do not provide enough information to allow providers to make informed decisions on appealing claims. Most insurance carriers do not routinely release detailed denial information to providers, even when requested, because disclosure is considered a right of the patient rather than the provider. This tool provides templates for three types of appeal letters: sample appeal letter for denial disclosure, sample interactive appeal letter for Level I appeals, and sample interactive appeal letter for Level II appeals. Each letter is accompanied by an explanation of when, why, and how to use it. This tool can save time in preparing effective appeal letters. The explanations also provide education about using appeal letters.