Payment Integrity: Denial and Audit Management Services
This is the second installment in our blog series on staffing shortages in healthcare and how Sharecare technology and services help bridge the gaps. Our first blog covered release of information (ROI) and audit services. In this blog, we will look at payment integrity technology and services that can help practices deal with denied claims, recover revenue, and avoid denials in the future.
Staffing shortages were already a serious issue in healthcare before the pandemic, including clerical support staff such as front office and accounting staff. With the pandemic, the problem has only intensified. Many staffers opted for early retirement during the pandemic in response to the added stress and demand on healthcare workers.
Today, many private practices and healthcare organizations are struggling to not only treat patients but also keep ahead of the volumes of paperwork and data filing required by payers for reimbursement.
But then, once reimbursement claims are filed, many are denied – in the US 10% of all claims submitted by providers are denied. The percentage is even higher in some specialties: 13% for Ophthalmology and 28% for Plastic Surgery. And denials are on the rise, with some industry sources showing denials for hospital claims were up 23% in 2020 compared to 2016.
Understanding the reasons behind any given denial and correcting or defending the claim can be complex and time-consuming, which is why 65% of denied claims are never resubmitted. This is a significant source of lost revenue for any practice or organization. But if you’re already short-handed, it’s hard for staff to carve out the time to work on denied claims, and it’s an area that requires special training and expertise to be successful.
Sharecare Payment Integrity technologies and outsourcing services offer practices and hospitals alike valuable tools for bridging their staffing gaps and getting more done with the staff they have – and retaining their current staff by lightening the load of administrative burdens.
Payment Integrity: Technology Helps Practices Avoid Denials and Revenue Delays
Payors’ reasons for denying claims vary widely, from simple coding and procedural errors to more complex reasons around the quality of care and necessity of treatment. With improved fraud, waste, and abuse (FWA) detection technologies being implemented by major payors, denial volume is also rising. However, the number one reason for not resubmitting claims after denial is the cost and administrative burden.
Sharecare Denial and Audit Management Services combine advanced technology with expert personnel and rigorous processes in a unique denied claims solution that resolves unpaid claim issues and lowers providers’ future denial rates.
Having a solution that manages all your payment denials keeps staff from handling the tedious follow-up, saving valuable time and bringing in revenue that would otherwise likely never be recovered.
Are you concerned about managing the many tasks that burden your staff when handling claims denials? Are you letting this revenue go uncollected because your staff doesn’t have the bandwidth or expertise to resubmit claims successfully?
Staffing Shortages Aren’t Going Away, But Sharecare Can Help
If industry prognosticators are correct, staffing shortages will be part of the healthcare landscape for some time to come. Sharecare works with providers to help fill the gaps left by staffing shortages with technology and outsourcing solutions that fulfill administrative tasks that are necessary but not clinically focused. We support any size practice, clinic, hospital, or healthcare system to help them continue to thrive in this new and, at times, challenging environment.
In the next blog in this series, we’ll look at how Sharecare Remote Patient Management Solutions can help empower patients to reduce care gaps and ensure patient conditions are managed more effectively during and in between encounters of care.
For more information on Sharecare Provider Solutions, visit:
www.sharecare.com/solutions/provider
All together, better.