MANASQUAN, NJ – Prompted by a survey that found an alarming rate of health plan claim denials, a special telephone management briefing on denial management has been scheduled by the Managed Care Information Center (MCIC).
An average of 18 percent of health claims are routinely denied by managed care plans, according to providers participating in a survey by the MCIC. The survey results are being published in the Executive Report on Managed Care.
The management briefing, "How to Optimize Your Organization's Cash Flow by Effective Denials Management," is scheduled Wednesday, September 29, at 1:30 p.m. Eastern time.
"Feedback from surveys and comments by healthcare providers and health plan executives reinforce that claims denials are a serious business problem," said Robert K. Jenkins, CEO of the MCIC.
"So much so that hospitals, physician practices, and other healthcare providers are estimated to be losing millions of dollars each year," he added.
"50 percent of denied claims do not get followed up. They (health plans) bank on this," a manager of consulting services for a clearinghouse told us, Jenkins said.
The costs, both in lost revenue to health providers, and the labor costs of staff re-filing claims is significant, Jenkins said.
"The re-work associated with re-adjudicating claims to recover monies owed under the contract is labor intensive and time consuming not only for hospital staff but health plan staff." a medical center director of managed care operations told the MCIC.
There are two sides to the issue, the survey results revealed, Jenkins said.
"Among the problems that health and managed care executives told us were the principal culprits of denied claims are Ineffective claim processing systems, system interface issues, eligibility issues, poor quality control, improper coding, poor documentation, insufficient contract language, lack of training, and coding errors," Jenkins reported.
The experts who will conduct the tele-briefing are Barbara Aubry, RN, CPC, CHCQM, clinical business analyst for Info-X Inc., and Bill Phillips, FACMC, CHC, vice president and CRO of Revenue Strategies Inc.
Conference topics will include:
- The importance of knowing your 'denial rate' and your 'recovery rate',
- Current claim system,
- Edits - the different types of edits (field, utilization, compliance) that cause denials, and new types of edits being added
- Importance of appealing denials.
- Real life experience in dealing with claim denials
The 90-minute management briefing includes conference slide presentation materials and a 'live' dial-in question and answer period.
More details on the conference "How to Optimize Your Organization's Cash Flow by Effective Denials Management," are available online at:
For registration information by phone or for questions, call toll-free 1-800-516-4343.
The Managed Care Leadership Survey was conducted among health and managed care executives who are subscribers or members of the MCIC. Responses were gathered online at the MCIC's Web site, www.themcic.com.
For Information Contact:
Robert K. Jenkins
Managed Care Information Center
1913 Atlantic Avenue F4
Manasquan, NJ 08736