Using Your Denials Management Software for Grouping Denials Codes into Categories
Does your Denials Management Software give you the tools necessary to determine the root causes of your denied charges?
If this is something you are working on, one problem facing an analysis is the fact that there are approximately 140 different denial codes.
That presents a lot of different moving pieces and complicates the analytic process.
A good way to approach the problem is to group the Denied Charges Codes into “like” categories. An example of a “like” category could be all Denial Codes that fall under the responsibility of the Registration Department.
However a client chooses to group the Denied Charge Codes is up to each facility. The important concept is to bring the 140 Codes into a manageable number of groups or categories.
A facility may have as many Denial Categories as they want. We recommend between 8 – 10.
For example, many of our clients have a Denial Category called “Eligibility Related Denials”. This category is made up of about 8 different Denial Codes, all of which are reporting that your claims were denied for Eligibility related reasons. For some of our clients all 8 Eligibility Denial Codes fall under the responsibility of the Registration Area. So why look at 8 separate Denial Codes when really they are under the same area of responsibility?
Using the Denial Category grouping method of analysis makes the trending, tracking and decision making process much easier.
It is important your Denials Management Software provide you the tools to create and manage Denial Categories.
The best way to “work” denials is to prevent them. Grouping into categories will allow a facility to understand the root causes and take corrective steps to prevent as many Denied Charges as possible.
Feel free to contact us at (619) 920-6147 or firstname.lastname@example.org if you would like more information.