Denial Coding Guidelines

Claim denials are amongst the topmost sources of revenue loss that have a direct impact on the cash flow of healthcare organizations. Denied claims alone have costed Hospitals across the U.S, a staggering $262 billion a year—leading to major financial losses and increased recovery costs. Consider that an average claim denial rate is at 9%—leaving about $5 million of money on the table.

Though there are multiple factors causing claim denials, coding errors are amongst the primary reasons for denials. However, the good news is that 90% of denials are preventable. With a strategic approach and a streamlined denial management process, Hospitals and medical practices can manage as well as prevent future denials.

5 Strategic Ways to Manage Coding Denials

The denial management services involve complex workflows that require a focused strategy and a nuanced approach to achieve sustainable results

• 1. Educate. Providers about digital documentation that supports medical coding and collaboration
• 2. Credential. Ensure that the medical coders are certified and updating their certifications through continuous learning
• 3. Create. Specialized workflows for denial resolution. This will also provide actionable insights on denial prevention
• 4. Confirm. Use technology, such as advanced scrubbers, to confirm payer coding rules are followed
• 5. Increase. Efficiency and mitigate human error by using a single platform for codingrelated activities

Learn more about how SolvEdge’s denial management services can accelerate your revenue cycle performance.
Contact us – 48 hours is all it takes to get your No Cost Root Cause Analysis to prevent denials from the ground up!