The Cost of Medical Coding: Assessing Denials and Defining Technology’s Role in the Future of the Healthcare Revenue Cycle
Overview
On average, $5 million worth of claims are initially denied annually per hospital. However, a more staggering fact is that 86% of those denials are avoidable and 65% of denials are never reworked.
By focusing on preventing denials, organizations can significantly improve their financial health. Collection rates increase, time to collect decreases, and staff expenses related to working claims and appealing denials is reduced. However, building a process to reduce denials takes time so organizations also need to make a concerted effort to rework and appeal denials to ensure they are not leaving any revenue behind.
AGS Health offers a variety of ways to control and avoid denials.
Preventing denials before the patient visit
With 50% of all denials caused by front-end revenue cycle issues, ensuring proper eligibility and authorization has never been more critical. Our patient access services and bespoke automation solutions ensure that financial clearance information is comprehensive and consolidated, providing continuity across the patient experience and mitigating financial risk.
Incorporate coding and CDI technology
Ensure your coding is accurate with computer-assisted coding and CDI software. Medical charts are reviewed using Natural Language Processing and AI to provide clear code and query suggestions, identifying areas of improvement and leading to faster and more accurate coding.
Supplement your coding staff with outsourced labor
Control operating costs, improve quality, and reduce denials by outsourcing your professional and/or facility coding. Our highly trained staff can manage all your coding with 95+% coding accuracy to reduce denials and improve revenue flow. Plus, we can recommend front-end edits to identify problems before they happen.
Ensure proper follow-up on claims and denials
By outsourcing your follow-up process, you can improve your revenue flow and resolve denials, underpayments, and lack of claim response. Our team achieves 95% resolution of A/R addressed using an analytics-driven work allocation strategy for timely follow-up, improved productivity, and rapid resolution.
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