Claims processing and denial management
Paper details: Post claim submission Denial management is a key function of revenue integrity. To begin to understand why denials are occurring, denial management teams track denials and then utilize dashboards or trending reports to assist with root cause analysis. Create a system (spreadsheet or other tool) to track denials. Data elements that should be included in the system are: 1. Encounter identifier 2. Payer 3. Denial type 4. Date of denial 5. Total charges 6. Amount denied 7. Denial reasonDownload Denial reason 8. If appeal was initiated 9. Claim resubmitted 10. Amount recovered Once you have created your tracking tool, populate it with 12 denied claims. Download 12 denied claims.Note: for items 8-10, you can simulate this data; it will not be on the RA provided. Consider the denial reason and if the healthcare organization is likely to appeal, correct and resubmit, or write off the charges. Using the information entered in the tracking tool, create a dashboard for January 202X. You will need to create some fictitious data related to appeal success rate, denial rate, and write-offs to populate your dashboard and report (i.e., patient service revenue). The metrics to include in your dashboard are: 1. Denial rate 2. Denial write-offs as a percentage of net patient service revenue 3. Top denial reasons by payer 4. Appeal success rate You should have one display for each item. In a summary statement, discuss what information the dashboard provides to the revenue cycle team about claim denials for this facility? Submit both the tracking tool and the simulated dashboaaqwrd with summary statement for grading.
