How one of the nation's largest integrated healthcare systems utilized I/O Surg and avoided over 1.3 Million in denials the first six months.
The future financial landscape for healthcare suggests that Center for Medicare and Medicaid Services (CMS) reimbursements will continue to decrease while an increasing proportion of patients will be insured by CMS plans as the aging population grows. One particular area of opportunity for improving revenue is mitigating losses within the arena of claim denials. Claim denials are costly and may occur anywhere within the revenue cycle.
The accepted benchmark in the industry is about 2% in claim denials for hospitals, which translates into millions of dollars of lost revenue annually. Given that most hospitals now operate on a 2% operating margin on average, the impact of claim denials can be staggering.
It is estimated that about two-thirds of denials can be recovered, but importantly, upwards of 90% are preventable. Many hospitals and health systems focus a great deal of effort in appealing denials rather than focusing efforts on prevention. Change Healthcare estimates that the cost for each claim is $118 per appeal – which adds up to $8.6 billion nationwide. Directing attention to prevention of claim denial should be paramount and span the entire revenue cycle.
Prior to I/O Surg, we would train, educate and do everything possible to reduce the amount we lost in denials each year. A lot of time and resources were spent with little results. Now, I/O Surg more than pays for itself by money saved each year and has significantly lowered our denials for Medicare patients."
While the denial can occur at any time, field experts agree that the majority of denials can – and should – be prevented on the front end.
A large percentage of claim denials can be attributed to processes that occur during registration, authorization, and eligibility. While education of front end staff is necessary and can be impactful, provision of tools to staff is essential to success.
At ProMedica, a process improvement initiative to optimize billing processes and enhance revenue cycle management was undertaken in 2017. I/O Surg was included in this multipronged approach; deployment for staff use began at a single hospital in June 2017 and was fully implemented throughout the system in Fall 2017. The application is used daily throughout the revenue cycle.
After I/O Surg was integrated into use, the figures related to medical necessity denials were reduced to $640,000 between July and December 2017, while no prior authorization denials dropped to $786,000. These reductions translate into denial avoidance for $1.36M of CMS gross charges in six months.
Right payment for your practice.
It is a tedious process, trying to get an entire hospital system using the right codes. On top of that, codes change every year and new books are issued with the revisions. The process with I/O Surg saves hospital systems millions in time, resources, and correctly scheduled procedures.
Right code for doctors and nursing staff
Select the correct procedural codes to identify specific surgical interventions quickly and accurately.
right schedule for office staff
Verify the codes are applied correctly during the practical process.
RIGHT SETTING FOR PRE OP STAFF
Verify the appropriate inpatient/outpatient status pre-procedure.
RIGHT REVIEW FOR Utilization Management AND CODING STAFF
One click to see whether change in surgical procedure is necessary post-op.
RIGHT BILLING FOR REVENUE CYCLE
Reduce non-reimbursements and streamline the payment process.