For many health care providers, denials—a refusal of carrier payment for services—are a pervasive feature of the revenue cycle. Tracking the where, the when and the why is a daily challenge, but it’s essential to recapture lost revenue.
A children’s hospital client can attest to that. The organization was challenged with consolidating various data streams resulting in hours and hours of report compiling and limited denials analysis. Client leaders knew there had to be a better way. They reached out to RSM US LLP for help and discovered that RSM had a custom solution just right for the organization.
According to the client, there was no easy way to pull data together from their clearinghouse and electronic health record system. Once they did run reports, their computers would time out when they tried to pull something like claim number by medical service type. They were wasting time and didn’t see meaningful results.
After evaluating the organization’s challenges and learning of their specific denials management needs, the RSM team presented a solution that could address their consolidation issues and provide custom reporting.
According to the client, they were excited after seeing RSM’s denial’s solution. It allowed them to get reporting by the payor; on a three-, six- or nine-month basis; by medical service type, and more. This was something they’d never seen before. The solution’s reporting identified denials immediately and saved hours of time.