Playbook Denials Quick Cash Play Icon
Denials – Quick Cash

Patient Financial Services // Difficulty: Simple

Why run this play?

This play identifies three denial types that are highly recoverable, so overturning them will help you convert net revenue to cash quickly. Besides preventing net revenue delays, these quick wins eliminate the risk of missing time-sensitive appeal deadlines.

Background

Our experience with clients suggests that 80 to 90% of three common denials can be overturned and a large portion of them can be prevented in the future:

  1. Date of Death Precedes Date of Service 
  2. Gender Mismatch
  3. Another Payer per Coordination of Benefits

This play gives you immediate insight into these three denial types so you can segment your denials inventory, spot root causes, capture collectable cash fast, and put systems in place to stop future problems before they happen.

Take Action

Date of Death Precedes Date of Service

  1. Look at the CARC and RARC codes in one side-by-side view and find straightforward lost recovery opportunities. Here, either the date of deceased or the date or service is wrong. This is a correctable denial that can gain new net revenue. Correct the date of service and resubmit the claim.
  2. Note that we often find transplant charges posted to the deceased patient account  rather than posting to the harvest account. Charges need to be moved to the harvest account.

Gender Mismatch

  1. Create a report from your 835 remits and review all remark codes for this CARC. These are correctable denials that need to be fixed and immediately resubmitted.

Covered by Another Payer per Coordination of Benefits

  1. Check guarantor demographics online, by IVR, or by calling the beneficiary (for card copy or any other document). Identify which insurance is primary, then submit the claim to the appropriate payer.
  2. For COB conflict, call the patient if the balance is above $2,500 and advise them to update their correct benefits information to payer. Otherwise, bill the patient and send a statement if the balance is small, or if it’s for the first visit.
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How to Calculate This Play's Value

  1. Keep track of the date you identified these denials at the account number level.
  2. Look for any associated payments from the same payer that came in after the tracking date.
  3. Multiply the payments by a reasonable cost of funds %. (For example, assuming a 5% cost of funds.) If the payments are $100, the acceleration is 5% of $100, or $5.

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