A comprehensive denial management approach is critical for increasing revenue cycle efficiency. Healthcare firms are implementing aggressive leaps such as lowering operating expenses and claim automation. Claim denials continue to be one of the most persistent and costly issues confronting healthcare systems. According to a study published last year by the Healthcare Financial Management Association, $262 billion in total claims submitted by healthcare organizations were refused, equating to over $5 million in denials per provider on average.

The fact that the majority of refused claims are avoidable is merely one facet of a much larger issue. It takes time, money, and resources to rework claims.

Denial Automation via Robotic Process Automation

Manual approaches are used by many healthcare institutions to manage and avoid denials. However, claim automation may significantly reduce costs and improve operational efficiencies. A typical individual spends roughly 18 minutes trawling through medical data to locate the exact information needed. On other hand, automated bots take less than two seconds. RPA-powered solutions free your team from time-consuming administrative procedures, allowing them to focus on high-risk accounts and other high-priority operations. RCM automation has the potential to significantly improve your denial management process.

• When denial and payment are received on the same day, RPA eliminates redundant denials.
• It prevents denials due to non-coverage by recognizing them early.
• Account funds are automatically transferred to the appropriate recipient.

Automated Denial Management Framework

A well-organized denial management provider creates a strategy workflow to prevent rejections by combining analytics and denial automation tools.

1. Discovering the root causes of Denial: To study denial trends and discover the intricacies of typical denial grounds, root cause analysis methods such as matching claims and remitting are used.

2. Collect information on Denial Appeals: Intelligent bots gather important data on denial appeals in order to identify the root causes. A forecast report on the outcome of the denial appeals procedure is also established.

3. Real-time Reports:  To provide accurate, real-time reports that give managers useful information, RPA insights are merged. These insights enable proactive denial management strategies.

4. Monitor the status of appeals for claim denials:  Automated appeals batch-fill personalized appeal letters to speed up refunds. To guarantee prompt and accurate refunds, appeals must also be submitted within a week following refusal.

5. Slicing apart the Denials: Medical billing denials can occur for a number of reasons. The medical billing service team makes use of claim automation to set priorities and organize work based on value, difficulty, and likelihood of payment.

Key Benefits of Claim Automation

1.  In order to find the source of rejections and appeal denied or underpaid claims, RPA in RCM ensures enhanced denial management and efficient workflows.

2.  To identify questionable payments and rejections in the relevant team or automated work queues, RPA bots evaluate ERAs and apply rules. Automated medical billing reduces the need for manual aggregation of your rejection reports when identifying payers, and the priority with monetary amounts.

3.  RPA bots create KPIs utilizing data supplied by HFMA.

4.  RPA bots guidelines may be established to direct every stage of the denial/appeals process, prevent missing appeal deadlines, produce email alerts, and improve communication within the hospital or medical group.

Healthcare organizations are working hard to overcome claim denials and stay current but find it difficult to manage their denials and get reimbursed with their present systems. Fortunately, the battle is now over! Robotic process automation technologies for claim automation produce a priority-based, specifically tailored denial management system for your hospital or medical practice.