10 Dynamic Strategies to Powerfully Prevent Healthcare Claim Denials

10/21/22 • 21 min

Welcome to episode nine of the RevTech Rx Podcast- Your Prescription for a healthy revenue cycle! Streamline Health, a leader in pre-billing coding optimization, powers this episode.
Learning how to prevent medical billing denials is crucial for healthcare providers as claim denials continue to rise and inflate billing- and insurance-related costs (BIR). Our panel of experts discusses their five tips for denial prevention, which include simply communicating and verifying insurance prior to authorization. We also dig into more complicated tips such as setting up a line of communication between patient financial service teams and the clinical team for case management.
With these tips, revenue cycle professionals can gut-check their existing processes and perhaps learn new opportunities to reduce denials.
Connect with our panel of experts:
David Kosloski- Host
https://www.linkedin.com/in/david-kosloski/
Ian Sullivan- Senior Director at HealthRise Solutions
https://www.linkedin.com/in/iansullivan1/
Jodi Stewart- Senior Vice President of Services at Streamline Health
https://www.linkedin.com/in/jodi-stewart-8244a316/
Chapters
00:00 Introduction
00:43 Tip # 1 From Jodi: Using Pre-bill Auditing Technology
1:34 Tip # 1 From Ian: Understanding Payer Contracts
3:13 Tip # 2 From Jodi: Have an Updated Chargemaster
3:36 Tip # 2 From Ian: Establish a Revenue Integrity Team
5:40 Tip # 3 From Jodi: Expanding on the Revenue Integrity Team
6:45 Tip # 3 From Ian: Implementing a Pre-service Team
9:59 Tip # 4 From Jodi: Managing Out-Patient Claims
10:40 Tip # 4 From Ian: Optimize your H.I.S.
12:01 Tip # 5 From Jodi: Establish Key Performance Indicators
13:05 Tip # 5 From Ian: Build a Partnership Between Case Managers and the Revenue Cycle Team
14:03 How to Prevent EMR Gaps
15:48 The Importance of a Revenue Integrity Team
18:08 The Valley Between Case Managers and the Revenue Integrity Team?
20:00 Jodi's Summary of Her 5 Tips for Preventing Denials
20:20 Ian's Summary of His 5 Tips for Preventing Denials
21:00 Conclusion
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Previous Episode

What's the Definition of Good Medical Billing and Coding & How Do We Get There?

Welcome to episode eight of the RevTech Rx Podcast- Your Prescription for a healthy revenue cycle! This episode is powered by Streamline Health, a leader in pre-billing coding optimization.
Medical coding is where medical records from healthcare providers are translated into alphanumeric codes that inform the billing of treatment received. Coding patient records include important information such as diagnoses, severity, procedures, and services rendered. Medical coding also allows for in-depth analysis that informs the financial decisions of the hospital for the benefit of the community they serve.
Once the coding is complete, claims are submitted to the patient's insurance company or the billing department for reimbursement. When coding errors are present, healthcare facilities face a wide range of problems from over-billing, underbilling, compliance scrutiny, and even recoupment from insurance companies. When the stakes are so high for healthcare facilities, medical coders are tasked to uphold high standards. For medical coders, the goal is to have only five errored charts out of 100 charts coded.
95% accuracy is impressive in itself. There are, however, roadblocks that can get in the way of good medical coding. Errors can occur in the form of how the healthcare industry currently records patient records and support the medical coder. When hospitals invest in hiring experienced coders, providing consistent feedback, aligning communication with other healthcare facilities in the health system, and investing in software programs to validate medical coding feedback; medical coding professionals are enabled to break the 95% industry standard.
There are, however, other considerations healthcare facilities need to take into account when supporting the medical coders. Culture plays a major role in keeping good coders working. As the growing trend of quiet quitting ramps up, pay is just one of the concerns for many employees. Our panel also provides insights on how to build a sticky culture and support a successful career in the healthcare industry.
In this episode of RevTech Rx, we are joined by experts in the medical coding field to not only give you the six pillars to medical coding success but also how to keep good coders through professional development and support.
Connect with our panel of experts:
David Kosloski- Host
https://www.linkedin.com/i

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Next Episode

Exploring Partners for Revenue Cycle Management

Welcome to episode ten of the RevTech Rx Podcast- Your prescription for a healthy revenue cycle! This episode is powered by Streamline Health, a leader in pre-billing financial performance improvement.
Episode 10 is focused on 'Exploring Partners for Revenue Cycle Management' and features two great guests. Adam Seymour, Chief Product & Strategy Officer for Alpha II, and Hal Walsh, Vice President, Channel Partners for Streamline Health share their views on the pros & cons of selecting a partner to help optimize your revenue cycle.
From approaching partner discovery with a clear objective and an open mind to knowing when and where to assess progress and consider if it's worth continuing, this episode delivers lots of good insights.
Connect with our panel of experts:
David Kosloski- Host
https://www.linkedin.com/in/david-kosloski/

Adam Seymour- Chief Product & Strategy Office at Alpha II
https://www.linkedin.com/in/adam-seymour-372b45/

Hal Walsh - Vice President of Channel Partners at Streamline Health
https://www.linkedin.com/in/halwalshmba/

Chapters

00:00 Introduction

01:14 What does an ideal partnership look like?

05:17 Separating what providers want vs. what they potentially need

06:55 Hallmarks of a good partner candidate

10:04 Examples of bad partnerships

12:02 Establishing responsibilities prior to kickoff

13:35 Warning signs when considering candidates

15:05 Being prepared to pivot to new developments

16:48 Summary of positive partner attributes

17:45 Conclusion
---

NEW TO THE SHOW?

Browse through all our episodes (complete with transcripts) here.

Follow RevTech Rx wherever you listen to audio!

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Follow via Youtube (HD Video)
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Follow via Spotify (HD Video)
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Healthcare leaders, want more groundbreaking content? Be sure to follow our LinkedIn page for the latest topics to get your hospital in the most efficient form possible.