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Duplicate Denials Hiding Actionable DenialsDifficulty: Simple // HIM
Why run this play?
Accurate reporting of denials is often compromised because actionable real denials can hide under a variety of “duplicates”, which means some cash recovery opportunities are lost or not prioritized. Finding these duplicates can reduce total touches, and identify payers that erroneously deny clean claims.
Background
In many circumstances, it is not uncommon for a claim to be automatically re-billed. This tends to produce a significant amount of duplicate claims — and duplicate denials. Duplicate denials create a tremendous amount of extra work, since staff must not only research whether the denial was legitimate, but also whether it was already paid.
Many host systems and denial management software solutions only identify the last touch, or where the account currently sits, so denials such as Non-Covered Charges, Service Documentation, Coding Error, etc., remain hidden under the denial type Duplicate Denial. The solution is to carve out false positives and separate real duplicate issues from original, first pass denials that later became duplicates. This lets staff focus on properly filing appeals instead of merely resubmitting claims. Also, staff can identify payers that frequently deny clean claims, so they can be referred to management for intervention.Take Action
Quantify and categorize denials by measuring and reporting trends by denial type, department, procedure, and payer.
Identify those claims where the most recent claim was denied for Duplicate Claim, and where a prior claim was denied for either Non-Covered Charges, Service Documentation, Coding Error, Non-Covered Service, or Charge Capture.
Perform a root cause analysis to see what caused the original denial.
The denial team should follow up with insurance and resubmit claims where appropriate.
Want to see how to run this play in VisiQuate?
Request a demoHow to Calculate This Play's Value
- Identify the date you begin tracking these hidden denial types.
- Sum all payments that come in after they have been identified.
- In addition, calculate the overturn rate on all denials that were duplicate denials hiding these denial types. The trend should be going up.
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