Learn about an in-house approach to improving denials management productivity.
What are you focusing on to improve claims denials worked in-house?
Misty Brackett: “What we're doing at Erlanger is focusing on getting the right account in front of the rep at the right time. Currently, we have no way of knowing what the rep is touching and if they're even touching the right accounts. We do have staff that understand how to “get productivity” by just going in and putting an X in EPIC as a note. So, we're focusing on addressing claim status with a tool. We have a system that's coming in that put the right account in front of the rep at the right time. What it does is tell them, ‘this is the account that's most valuable.’ It may be the highest dollar claim, it may be the one that's about to miss timely filing requirements, or it may be a mid-level account that we would never have gotten to. The claim status tool will also tell us if an account is getting paid. If it's getting paid, then it will no longer present to the staff member. They will not even know the account exists.
"(With the tool), once an account gets to them, they will go into our EHR and look up the account and do their (processing and follow-up) actions. Then they will have to put a note back into our secondary system that pushes over into Epic Within this system that we have, it will have reporting on penetration testing that tells us exactly how far into our A/R we were able to get to. It tells us the status of what each rep has done. It also gives them a scorecard on their success rate. So, if they are touching accounts that are not good touches, then it will report that back to us. Also, we are going to have a bonus structure, which will allow reps to get one level of bonus if they hit a certain goal. When they go above and beyond in their success and productivity, then they will get a second-level tier bonus, which could add up to $3 to their salary each hour."