Learn how Hennepin ensures its denials strategy keeps pace with industry change.
What denials trends are you seeing, and how are they affecting your strategy?
Phillip Brooks: “Most of the time, denials are coming fast and furious. We are in the business of getting paid, seeking reimbursement from a revenue cycle perspective. But what I fear happens is insurance companies make unilateral denials. There are times when people deny our claims for no reason at all. The literature says, and this comes through HFMA as well as Becker's, that there are insurance companies that receive medical records and never even look at them. They just automatically deny, almost like it's an assembly line for denials. What I'm trying to do is get my people to understand that as consumers––which we all are, even though we work in revenue cycle––what happens when you receive a personal denial? You should work your accounts at the hospital the same way you would do for a personal denial. You would escalate it. You would find out what the problem is and what needs to be done to resolve that issue. Right there, staying committed to resolution (in the face of the toughest challenges) is one of the biggest things.
“The other side is that sometimes denials are based on how much money the claim is worth. And that kind of drives me nuts because it seems like there's a tier relative to if it's $50,000, chances of it being denied are, you know, 5%. If it's $100,000, it’s 90%. And anything greater than $100,000, it even escalates. And from that aspect, I think we just need to be prepared as a provider (with every high-dollar claim) to get that (missed information used as a basis for past denials) to them when we file the initial claim.”