Every health organization’s billing office or Patient Financial Services (PFS) team must deal with claim denials on an ongoing basis. However, it may be difficult to determine what factors are causing denials within your organization and how to address the root causes. It may also be challenging to identify which types of denials occur most often and what factors denied claims have in common.
Claims or charges may be denied for a variety of reasons, such as:
- Missing or invalid National Drug Codes (NDCs)
- Missing or invalid HCPCS codes
- Missing documentation to support charges
Denials create additional rework for your organization’s billing office and/or PFS team. Although not all denial root causes can be addressed through biller reeducation or Millennium build fixes, many can. Addressing these issues can ultimately reduce your organization’s denial rate.
As a billing office or PFS team, you may wonder whether you can track which denial types or CARC codes your organization is encountering most often. The next question is whether the root cause of those denials can be addressed by your team or organization. Without the proper tools, answering these questions can be nearly impossible.
Softek’s Claim Denial control provides information on denied claims across health plans, giving end users insights into why claims were denied and what factors those denied claims share.
It can quickly show:
- The most common denial reasons
- Which health plans experience the most denials
- Which attending physician are tied to accounts and charges being denied
Ultimately, the Claim Denial control can help highlight denial reasons—such as missing HCPCS—that may be resolved with a charge build update, thereby reducing denial rates for those types of claims.
Having this level of visibility provides your organization with greater insight into what needs to be addressed to reduce denials and improve overall efficiency of your system.
What does Softek® do?
Softek’s mission is to help hospital systems maximize their investment in Oracle (Cerner) Millennium®. We do this by providing innovative software solutions and consulting services that can achieve more together than either can alone.
At Softek, our team of innovators and software developers brings expertise beyond the ordinary to every client. Our experts are involved with Oracle (Cerner) Millennium® hospitals throughout the country, consulting clients so they can optimize system performance and revenue integrity.
Softek delivers a full suite of consulting services and software solutions to assess and optimize EMR system performance, including revenue cycle integrity and patient accounting.
Let’s talk about how you can get the most out of your Oracle (Cerner) Millennium® system.
