Denial management might be one of the most overwhelming steps of the revenue cycle, regardless of the size of your healthcare organization. But, in order to receive as much revenue as possible, you need a plan to handle your denials. In this webinar, we covered an ever-familiar scenario and show you a 7-step denial management process that will give you the results you're expecting by using a data-driven approach.

1. Data-Driven Denial
Management
Using actionable data to influence
your denial rate, work efficiently, and
increase your revenue.

2. Thank you for joining us!
Agenda:
1. Scenario
2. 7 Steps
3. Q&A
4. Special Offer
Alexander Ross
Sales Associate

3. Who are we?
What: Revenue Cycle Solutions
company
How: Developing advanced,
cloud-based software to help our
clients work more efficiently and
effectively

4. Scenario Introduction
Who: Ross Memorial Hospital
What: Mid-Sized Hospital
Where: Ohio
How: New partner with Etactics

5. Scenario Introduction
Who: Lisa
What: Revenue Cycle Manager
Problem:
● Noticing some denial issues
● Not able to quantify those issues.
● Has some data available
○ (or is able to compile it)
Lisa

6. 7 Steps for a Lower
Denial Rate

7. 1. Prioritize Need
Total # of Denials
Total # of Claims
= Overall Denial Rate
Total Dollars Denied
Total Dollars Billed
= Overall Dollars Denial Rate
Are you including all denials?
Partial paid?
Contractual?
Certain codes, but not others?
Ask Yourself...

8. 1. Prioritize Need
Lisa’s Denial Rates

9. What type of denial?

10. What type of denial?
1 Categorize
2 Rank
3 Tackle

11. What type of denial?

12. What type of denial?
Three Largest By Code
1 97 | Bundled with Other Service
2 59 | Concurrent Procedure Rules
3 N22 | Duplicate of Cross over

13. 2. Audit Progress

14. 2. Audit Progress

15. 2. Audit Progress

16. If your revenue cycle is a
garden...
3. Address New Problems Immediately
denials are your weeds.

17. 3. Address New Problems Immediately
Trend this...

18. 4. Inform Other Areas with Denial Data

19. 5. Identify Denials Intelligently
1 If you’re auto-posting, stop working denials that don’t need worked!
2 The time you spend on denials that can’t be overturned adds up!
3 Use CARCs and RARCs to your advantage.
4 Don’t use ‘zero-paid’ as your metric!

20. 6. Track Overturn Rate to Better Prioritize
You’re tracking denial rate, now track how much of this gets worked/appealed each month.

21. 6. Track Overturn Rate to Better Prioritize

22. 7. Reduce Workload Using Automation
● Auto-posting
● Auto-denial identification.
● Automated reporting.
● Automatically fill in forms.
Automation can’t train your staff, but it can help you find more
time for one-on-one conversations and continued
improvement.
(and redirect those resources to prevention!)

23. Thank you!

24. Special Offer
1 Check your email!
2 Complete your Revenue Vitals Checklist.
3 Some attendees will be eligible for a denial management
consultation.

25. Q&A

26. Thank you!
aross@etactics.com
330-423-0663