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Three Revenue Cycle Management Technologies to Prevent Costly Denials

Three Revenue Cycle Management Technologies to Prevent Costly Denials Frost & Sullivan white paper highlights which attributes can deliver the best ROI for denials management performance improvement and excellent customer value

PR Newswire

SANTA CLARA, Calif., Jan. 21, 2019

SANTA CLARA, Calif., Jan. 21, 2019 /PRNewswire/ -- Revenue cycle management (RCM) reinvention has come into focus in the healthcare industry as providers look for innovative ways to cope with the growing array of health plans with deep contractual and network complexities and almost constantly changing rules and requirements. There is an urgent need to optimize next-generation RCM IT and re-engineer RCM workflows and processes with solutions specifically designed to prevent costly denials.

Frost & Sullivan's new white paper, New Approaches to Denials Management: Perspectives from the Frontline, is a report on Frost & Sullivan's recently convened Virtual Think Tanks. The two Think Tanks brought together RCM thought leaders for a candid exchange of fresh ideas, approaches, and best practices that can increase RCM efficiencies. There was a special focus on the steps needed to mitigate the top RCM challenge of claims denials.

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"RCM reinvention requires leveraging IT tools to enable new approaches to data sharing across care settings and with other key stakeholders. It ensures better connectivity with payers and automation of repetitive tasks, which translate to higher efficiencies and revenue capture," explained Nancy Fabozzi, Transformational Health Industry Consultant at Frost & Sullivan. "The key to RCM enhancement is presenting enhanced analytics capabilities, including dashboards for trend tracking, analytics to assess the root cause of denials, report generation, decision support for workflow changes and resource allocation, and analytics for risk management."

"Our customers are reaching out to payers, talking to their peers and others in their market in an attempt to gather information about what they're experiencing," added Serene Munroe, Senior Director of Product Management at Virence Health. "They do this to determine what is normal for working with a particular payer. We support them through a combination of core technology attributes: robust analytics, connectivity for data sharing, and select automation. Together, those can deliver the best ROI for denials management performance improvement and excellent customer value."

Even though providers identify denials as their biggest RCM challenge, few have adopted denials management IT. A 2016 HIMSS study estimated that about 31 percent of providers are still using manual claims processes for denials management. To optimally tap the growth opportunities in denial management, RCM vendors need to:

  • Highlight the importance of workflow realignment, including strengthening communication across departments and functions, and educating and incentivizing staff to improve the quality of data and information capture.
  • Leverage novel tools to run root-cause and other analytics, produce reports to share across departments, automate routine functions, and perform a range of other tasks designed to improve staff efficiency and resource allocation, and better manage risk.
  • Improve the quality and accuracy of data collection, particularly at the front end.
  • Restructure RCM workflows to proactively address inefficiencies and silos that lead to denied claims and poor clean claims rates.
  • Centralize some RCM functions.

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Last Updated: 21-Jan-2019