Reducing Denials and Improving LOS

How can software improve denial management and reduce the risk of a patient being discharged too soon? 13 ways!

Reducing Denials 13 ways

How Can Automation Reduce Denials?

The top three reasons for UR denials include insufficient evidence of medical necessity, missing documents, and scheduling problems. BHCC solves these challenges.

  • BHCC scores evidence of medical necessity. This allows UR staff to identify cases needing additional documentation to decrease the risk of a denial. This helps the facility increase revenue through longer length of stay (LOS) as clinically appropriate based on symptoms.

  • BHCC strengthens peer-to-peer reviews. It clearly highlights all the new documentation since the last review. Denial tracking aids communication with providers through call scheduling and an integrated calendar. This provides a shared record of the peer-to-peer calls between providers and UR nurses.

  • BHCC enhances collaboration. Automated alerts and notifications of pending deadlines and missing documentation reduce the need for UR nurses to chase down providers.

  • BHCC strengthens the final appeal process. With continuously updated documents, it ensures a complete documentation record when submitting the appeal. 100% document completion prevents surprises!

  • BHCC tracks denials. By review call, insurance provider, and diagnostic class. Clinical performance KPIs show peer-to-peer success rates, highlighting strengths and weaknesses for process improvement.

Denial Management Before, During, and After the UR Call

How BHCC bolsters LOS management before, during, and after UR calls

BHCC bolsters LOS management at pre-call assessment, during the call, and after an insurance denial.

  • Pre-call assessment: Tightly scheduled insurance review calls often cause UR staff to rush to the review without enough evidence of medical necessity. This leaves them scrambling to answer questions during the call. Automated processes continuously scan the EMR for information. A ranking and scoring model allows the nurse to know in advance which patient cases are strong and which require additional documentation. This ensures sufficient preparation for each call.

  • During the call: BHCC’s up-to-date patient summaries provide evidence strength and rapid access to supporting documents during the call. UR nurses can become quickly familiar with new or new-to-them patients and have the strongest document excerpts on one screen. They can answer questions with direct quotes and easily view document sources. This improves presentation quality and decreases denials. Your UR staff is on top of all their patients’ information!

  • Post-call review: After a concurrent review call resulting in a denial, the UR nurse notes the “denial reason.” This provides insight for process improvement. If a peer-to-peer is indicated, the provider and UR nurse receive automatic confirmation of the time and date. You know who’s accountable! The patient summary quickly shows the provider of the status with supporting documents, with a clear indication of new content since the last call. This allows the peer-to-peer provider to focus on their assessment and new information rather than the need to search for evidence.

The Proof Is in the Metrics

Management insight KPIs drive decision-making by providing proof that processes are working well and revealing ways to improve. Reducing denials requires metrics to highlight issues and negative trends and to drive continuous improvement.

Increased Insight

Your Facility Will See Results With BHCC!

See results

  • Reduced denials

  • Expanded economic sustainability

  • Increased revenue

  • Improved UR operations through KPIs

  • Fact-based insurance negotiations

  • Improved care with the insurance authorization as clinically indicated for the patient

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