Denial Management
Denial management is what differentiates SSC from other revenue cycle management providers.
The operational method for a successful denial management process is integrated throughout the organization. The following are only a subset of the activities that take place.
On the front end, our daily claims are stamped and verified as received at the individual charge level. Any claims that are denied or cannot be submitted through our claim vendors are cross-mapped to rejection code and tagged with the reason for rejection.
These rejected charges are then routed to a claim team that resolves the edits the following morning. All available charges, payments and rejections are posted at the charge line level. This is a critical precursor to effective workflow and denial management reporting.
Charges that have payments or rejections/denials applied to them are also routed to specified reports and Paperless Collection System (PCS) work queues to be processed by teams assigned to those accounts.
Denials are posted daily at the charge line level and electronically routed to the collection team for resolution.
The collection team is responsible for working the denial through to its resolution within the same week of the compile; the team is specialized by payor.
With the exception of coding denials (worked specifically by the coding team), the collection team is responsible for all other denial types.
All clients of SSC are monitored through the use of customized internal reporting. This reporting, focused on claim status, days in accounts receivable, days in accounts receivable over five months, etc., are utilized to monitor both client, as well as staff performance.
Through the use of detailed and high-level metrics, staffing levels can be adjusted across clients and individual performance can be evaluated to provide focused training.