Mistakes made during the registration process mean money down the drain. Even a single-digit denial rate still results in tens of thousands of denied claims for large health systems each year.
Denials are a persistent problem, with up to 1 in 5 claims delayed or denied. All of these medical claims have to be reworked or appealed — and rework costs average $25 per claim (with success rates from 55-98%, depending on the medical denial management team’s capabilities.)
Chances are, your denials management process show denials coming from the clinical side, but they are more often the result of registration information not being processed correctly. In fact, the top five reasons for medical billing denials are:
- Missing information
- Duplicate claim or service
- Service already adjudicated
- Not covered by payer
- Limit for filing expired
Over 90% of all denials are preventable at the front end. Whether these errors originate with access, scheduling, pre-registration or insurance verification, the Patient Access Manager or Director is the one held responsible.
If you are continually seeing your staff make the same mistakes with data entry, eligibility and benefits checking, coding or another aspect of pre-registration, AccuReg is here to help.
Stop managing denials and start preventing them.
One of the best ways to secure cash is to get it up-front, prior to or at the time of service. The AccuReg solution will automatically eliminate many of your most common causes of denials — thus increasing collections prior to service.
And when you’re doing everything right on the front end, your back-end expenses are minimized as well.
AccuReg automatically audits scheduled, pre-registered and registered accounts for specific error types. We incorporate your payer’s denial patterns and alert your front-end staff to ensure real-time resolution before the denial can happen.
AccuReg uses best-in-breed automation solutions to eliminate errors through the following processes:
- Demographic and insurance verification
- Authorization screening and capture
- Medical necessity screening
- Quality assurance auditing and resolution
- Financial assistance screening
- Patient estimation and pre-service payment
AccuReg will make sure an insurance company or carrier pays for healthcare services by alerting you to errors in any of the following:
- Registration data entry
- Pre-authorization and medical necessity
- Eligibility and benefits checking
- Clinical documentation
- Claim editing
- Changing regulatory requirements
What AccuReg Denials Prevention Gives You:
- Embedded training based on individual patterns. Our Integrated IntelligenceTM learns registrars’ performance and error patterns and recommends training “on the fly” to improve performance.
- Intelligent guided registration with tailored scripts to guide the registrar through tricky or sensitive situations. Registrars will know what to say, when to say it and how to say it.
- Standardized process automation that auto-corrects subscriber data from the payer without user intervention.
- Registration Quality Assurance (QA) that sends escalation alerts to supervisors. This allows for intervention prior to submitting a claim, reducing errors prior to submittal.
- Failure escalation that means if an authorization code is not obtained, an alert is sent to the registrar and the supervisor. Supervisors get involved at registration rather than at collection.
- Individual accountability tracking that tracks all unresolved issues in individual performance metrics. The result? Performance improves. Weaker players are coached as needed or weeded out.