Expert Insight: Answering Top Denials Questions

By Kindred Hospital Rehabilitation

Both commercial and public payers are now denying about one in every 10 submitted claims, costing health systems up to 2% of net patient revenue, according to a recent study from the Advisory Board1.

Answering Top Denials Questions

Due to this substantial increase, many providers are looking for answers surrounding the industry’s most pressing denials questions. Find answers to three of the top denials questions impacting health systems today from Kindred’s appeals and denials expert, Emily Morgan, JD, SLP:

  1. What are the trends in denials we have seen over the past 5 years?

    Answer:
    In the past, denials were prevalent among orthopedic admissions. Recently denials have shifted to shorter stays and the 40% admissions, especially for non-surgical admissions, such as pelvic fractures, UTI, GI and metabolic diagnoses. Additionally, denials are increasingly more universal, rather than regional, although each Medicare Administrative Contractor (MAC) may focus on a different aspect to monitor within their territory. 

  2. What trends should we continue to expect for claim denials?

    Answer
    : Regulatory requirements must be met to ensure that Medicare funds are spent appropriately. However, denied claims may very well trend down as sites improve their ability to document supporting medical necessity.

  3. What tools can you put into place to limit denials?

    Answer
    : A structured support plan provided by a knowledgeable and experienced team of appeals specialists will help limit denials. Further, due to the complexity and specialization often required, many health systems are finding success through focused support from a dedicated rehabilitation partner that has the proven expertise in limiting denials. 

Now more than ever, having a dedicated partner that can remove the burden of running a full-service hospital program and help overcome key challenges, such as denials, can enable your facility to focus on what matters most: the patient.

Read our whitepaper, “Ask an Expert: 10 Things to Know about Denials” to uncover more vital answers surrounding denials.


References:
1. Revenue Cycle Advancement Center’s 2017 Hospital Revenue Cycle Benchmarks, Advisory Board

By Kindred Hospital Rehabilitation