Service To Cash Improvement
Claims submitted to insurance providers resulted in an unacceptable level of denials. In these cases, service to cash transactions were breaking down. Services were provided but were either not paid for, or were paid at a level less than expected. This led to lost revenue and excessive time spent following up on denials. The objective was to reduce the number of denials and act upon remaining denials quickly, resulting in increased revenue and shorter collection.
Analysis of service to cash, in particular the denials, revealed that required information was often missing from billings; providers had not been adequately challenged in some denials and people submitting billing often coded in a manner that led to lower payment. Process improvements were made to ensure that required information was provided to the people submitting billing. The collections process was changed to more rigorously review all payments and denials.
Billing receipts for denials increased over 60% and other ‘policy constrained’ areas of the operation were reviewed.