Claim Denials & Appeals Management
Proven RCM end-to-end consulting services for improved denial prevention and appeals results.
AQuity Claim Denials & Appeals Management Solutions
AQuity’s Revenue Integrity team offers proven end-to-end denial and appeals management consulting services for improved denial prevention and appeals results. Our experienced team goes beyond addressing an individual claim by identifying the underlying issues, whether it be documentation or coding, to prevent repetitive errors. AQuity’s tailored solutions focus on consistency and transparency, with real-time monitoring to ensure our clients can maintain a healthy cash flow.
AQuity Best Practices
Effective management of Claims Denials and Appeals is crucial to the financial well-being of healthcare organizations. AQuity helps clients maximize justifiable revenue while ensuring compliance.
Understanding Denial Patterns
AQuity Denial and Appeals Management experts understand how to identify recurring issues and patterns to pin-point the root causes of denials. These efforts lead to proactive measures that effectively prevent future denials.
Clear Processes
Development of standardized Denial Management process and workflows ensures ongoing denials result improvements. These efforts include clear team member roles and responsibilities, denial tracking standards, and issue escalation procedures.
Thorough Documentation Analysis
Accurate and comprehensive documentation is required for effective ongoing care and optimal justifiable revenue. Understanding the complete document creation lifecycle and exactly where to go to research and resolve Denial notices is essential for efficient Appeals management.
Timely Submission of Appeals
How well you manage your Appeals process can have a significant effect on your cashflow. AQuity experts adhere to all payer specified timelines to avoid unnecessary additional delays. This includes a robust Denial tracking system to monitor and manage appeals effectively.
Dedicated Staff
Effective Management cannot be achieved if assigned as a secondary responsibility to any team members. Designated, experienced staff who are knowledgeable with denials and appeals, insurance regulations, coding guidelines, and payer specific reimbursement policies are needed to avoid extended delays and avoidable write-offs.
Keeping Current with Coding and Billing Regulations
Successful Claim Denials and Appeals Management requires constant monitoring of changing coding and billing guidelines, along with constantly evolving government regulations, payer policies, and other industry updates. AQuity helps ensure compliance and minimized denials through company-wide updates with all Claims Denials and Appeals Management team members to minimize denials based on allowable date specific coding errors or incorrect billing practices.
Strategic Implementation of Technology Solutions
AQuity believes in leveraging technology tools such as claims management software, automated denial workflows, and analytics systems to streamline denial management processes. At the same time, AQuity recognizes not all tools work the same for all case types and all technology solutions need to be cost justified. The AQuity Difference is meeting our clients based on where they are in their personal technology adoption journey and maximizing results based on the tools and workflow limitations available – while making investment recommendations when cost justifiable based on our experience with other clients. Such cost justification analytics are especially important with Claims Denial and Appeals Management solutions which rarely apply equally across all case types.
Conduct Root Cause Analyses
Detailed root cause analytics identify the underlying reasons for claim denials and/or efficient appeal approvals. The AQuity Revenue Integrity team helps clients optimize their corrective actions to prevent similar denials in the future.
Education and Training
The AQuity Revenue Integrity firmly believes in the value of ongoing education and training for all participants in the document creation, coding, billing, and downstream workflow process. Ongoing training ensures documentation best practices, coding accuracy, adherence to payer policy requirements, and denial management strategies. Regularly communicated updates and changes to such policies ensures optimal performance and minimized denials.
Ongoing Performance Metrics Monitoring
Clearly defined Key Performance Indicators KPIs are essential to the effectiveness of your denials management process and results. Consistent monitoring and reporting of details such as denial rates, denial turnaround times, and appeals success rate by case types and payers are needed to identify areas for improvement and to track program progress over time.
Speak with an AQuity Claims Denials and Appeals Management Specialist
AQuity is a nationally recognized leader in Claims Denials and Appeals Management. Contact us today to discuss your objectives and learn how we can help.
Key Differentiators
- AQuity provides an end-to-end approach for complete denials and appeals management for a more effective denial prevention process.
- Payment audits and denials do not rest solely on the finance team; When it comes to denial management, there is no “one-size-fits-all.”
- The AQuity Revenue Integrity team conducts targeted trend probes followed by deliberate focused education to prevent chronic recurrence to avoidable issues.
- Beyond a standard assessment and reporting, AQuity identifies payor trends, providing feedback with associated recommendations for implementing corrective actions.
- We provide concrete preventative measures to reduce the overall number of claim denials, resulting in optimized cash flow.
- AQuity helps all stakeholders understand the causes behind payer denials and provide ongoing training on continuous changes to coding requirements or payer expectations.
- Detailed reporting to summarize trends, including details of specific denials and recommendations for overturning with payer specific resubmittal strategies, resolution rates, and claim appeal values for roll up to Finance and Revenue Integrity.
- Corrective action recommendations are tailored to applicable stakeholders to help pinpoint trends and issues that can be corrected prior to claims submission.
AQuity provides an individualized, calculated approach for Claim Denial and Appeals Management. Numerous areas within the revenue cycle process allow for the creation or prevention of denials. AQuity’s unique approach not only identifies such areas of concern, but also offers tailored recommendations and guidance to decrease denials, improve cash flow, and alleviate the administrative burden in appeals management.
Learn More by Speaking with a Solutions Specialist Today.
AQuity is a nationally recognized leader in Claims Denials and Appeals Management. Contact us today to discuss your objectives and learn how we can help.
