Obliterate claim denials with a modernized patient access engine

Published: March 21, 2024 by Experian Health


Labor shortages and the uptick in claim denials are undoubtedly putting heavy financial strain on healthcare providers. Could automated claim denial prevention help ease the pressure?

In a recent webinar, Jason Considine, Chief Commercial Officer at Experian Health, and Jordan Levitt, Co-founder at Wave HDC (recently acquired by Experian Health), discussed strategies to tackle denials head-on in the coming year. This article summarizes the key insights, including a new automated one-click denial prevention tool that shifts denials management to the front end of the revenue cycle.

5 revenue cycle challenges causing claim denials and strained margins

To start, Considine opened the webinar with a discussion of the root causes of denials. These often originate during registration, and for many providers, “registration and data integrity continue to be a problem.” A fifth of denials are attributed to just five key issues:

  • Coordination of benefits (COB) denials, which account for a major portion of denials as more patients have secondary and tertiary coverage;
  • Contingency fees, which eat up margins in exchange for information that providers should be able to obtain themselves during registration;
  • Labor costs, which can increase with labor-saving automations that push manual input downstream;
  • Epic plan mapping, which becomes increasingly complex and error-prone as payer requirements evolve;
  • Transactional pricing, where “pay-per-click” pricing models disincentivize providers from using registration tools to find patient information during registration.

These interrelated issues should be solved with one up-front revenue cycle management (RCM) solution, rather than piecemeal fixes that are implemented later. According to Considine: “Vendors tend to offer ways to solve these problems after the patient leaves, but really we should have gotten the right information right up front. Pushing problem-solving downstream means you need more people to manage these solutions, you’ve got more vendors to manage, and you end up staffing denial management departments and throwing more people at the problem.”

Shifting from denial management to denial prevention

Part of the challenge is the sheer volume of patient information that must be collected from the start. Staff interact with multiple systems to collate, check and coordinate data on eligibility, COB, Medicare Beneficiary Identifiers, demographics and coverage. Many of these data points can be points of failure if the wrong information is captured and penetrates the rest of the system.

This makes patient access the perfect place to solve the denials problem. Levitt says this is exactly what Wave HDC set out to do when they developed the technology that underpins Patient Access Curator. “The answer isn’t multiple clicks, running one transaction at a time. With Patient Access Curator, you can know everything about the patient to run a clean revenue cycle process and propagate only clean data downstream, all within two to thirty seconds.”

Patient Access Curator prevents denials by capturing all patient data at registration through a single click solution that returns multiple results in less than a minute. It’s fast because the underlying code acts like a Rosetta Stone, automatically translating the language of the user and the health system into the terms required by the payer. This means data can be transferred easily between interfaces.

Levitt explained how the tool builds a “perimeter defense against bad data,” by ensuring data accuracy from the start. Bad data is less likely to propagate through the system, which reduces the risk of denials. As a result, clients using the tool have been able to reduce contingency volume by over 60%.

Introducing the next generation of smart RCM technology

Many organizations are investing in staffing to address claim denials, but this approach is not effective in the long run. Levitt described how preventing denials calls for technology that’s built for today’s challenges.

“Most tools out there are built to manage the problems of the last twenty years. But twenty years ago, we didn’t really have COB issues. Patients were either insured or uninsured. Now, some are over-insured and some are under-insured. You see more patients come in with one insurance card in their hand, but with two, three, or four other coverages. It’s much more complex. Patient Access Curator makes it simple by bundling all the transactions into one.”

The technology uses artificial intelligence, in-memory analytics, and robotic process automation to verify eligibility and COB, find and fix patient identifiers, check contact information, and generate information about the patient’s propensity to pay.

And the result? Providers can simplify denials management even as the insurance and operational landscape becomes more complex.

Watch the webinar to hear the full discussion and find out more about how Patient Access Curator helps healthcare organizations capture accurate patient information at registration with a single click.

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