Coordination of benefits (COB) denials can create an accounts receivable backlog for hospitals and detract from an otherwise positive patient experience. What’s more, these types of denials can be costly––negatively impacting up to 1% of a hospital’s net patient revenue and draining significant staff time in research and follow-up.
As it is at many organizations, the financial team at Yale New Haven Health, a nonprofit healthcare system spanning CT, NY & RI, knew that COB denials presented an area of missed revenue opportunity.
But how to improve this area when in-house staff was already focused on higher revenue cyle priorities and not seeing enough traction from the follow-up activities they did pursue?
Revenue Cycle Challenge: COB Denials
Yale New Haven’s COB denials were negatively impacting cash collections and aging accounts receivables. The revenue cycle team was diligently working the denials internally, but many of the claims were going to bad debt because patients weren’t responding to requests for additional information, such as accident details, prior medical history forms, retirement, workers’ compensation, or eligibility updates.
Also, in the absence of account resolution, patients received repeated statements and requests for payment, which led to confusion and frustration with the health system's billing process.
“We were looking for a better way to work these labor-intensive denials that would enhance the patient financial experience while delivering more dollars to the health system’s bottom line,” notes Sharlene Seidman Vice President of Patient Financial Services at Yale New Haven Health.
The revenue cycle team knew that with 124,668 inpatient discharges and 2.4 million outpatient encounters, Yale New Haven Health's COB denials improvements presented a significant opportunity.
Partnering to Resolve COB Denials
The health system engaged Knowtion Health to serve as a relationship-building extension of Yale New Have Health’s denial management team. Knowtion Health’s denials program regularly helps recover 65 to 75% of COB denials, as compared to the 20 to 30% recovery rates that health systems typically recover on their own.
Knowtion Health’s dedicated team worked Yale New Haven’s accounts after Day 30, utilizing a proprietary workflow technology and a TCPA-compliant approach to resolve the denials. Analytics also track the most common reasons for a COB denial to provide the organization with a feedback loop and recommendations to aid future prevention.
Equally notable, Knowtion Health’s COB expertise proved useful in using communications that were effective and patient-centric. Knowtion Health’s team is experienced in patient communication to aid next-step actions for resolution. Representatives from Knowtion Health will often arrange three-way calls with a patient and their insurer to ensure all missing information is obtained efficiently. Depending on the situation, Knowtion Health can even conduct home visits with patients to obtain needed information and help patients with paperwork.
In some instances, Knowtion Health is even able to resolve the denial without patient involvement by successfully appealing denials based on a payer’s unfounded refusal to pay.
Denial Management ResultsWith Knowtion Health's help, the health system:
- Collected $1.4M average monthly COB-related revenue by assisting patients with COB denials
- Improved aging A/R by resolving COB-related denials within 79 days on average*
- Improved the patient financial experience by helping patients understand the information insurers needed and why
*Resolution = cash collected or balance posted to deductible or copayment
Discover the Knowtion Health Difference
Could your hospital use assistance with its COB denials program? Contact Services@knowtionhealth.com to speak to a representative about your organization's goals and needs.