Post-Acute & Long-Term Care Denial Management - Element5

Post-Acute Care
Post-Acute & Long-Term Care Denial Management - Element5

In today's intricate healthcare landscape, post-acute care organizations are grappling with a myriad of challenges, from regulatory compliance to financial sustainability. Among these challenges, claim denials stand out as a significant concern that impacts revenue recognition and overall operational efficiency. However, the advent of automation technologies offers a newfound hope for mitigating these challenges and driving positive outcomes for post-acute care providers.

Automation has emerged as a game-changer in the healthcare industry, presenting a transformative opportunity for post-acute care organizations to streamline processes and reduce claim denials. Leveraging advanced technologies like artificial intelligence (AI) and Robotic Process Automation (RPA), these organizations can optimize workflows, enhance accuracy, and eliminate inefficiencies that contribute to denials. Automated systems can proactively analyze claims data, flag potential issues, and facilitate real-time communication among stakeholders, ensuring compliance, reducing discrepancies, and ultimately accelerating revenue recognition.

Healthcare Claim Scrutiny and Compliance

Healthcare claims are put through an inordinate amount of scrutiny before payouts, largely due to the plethora of healthcare regulations and guidelines. Newer compliance-based regulations levied by the Centers for Medicare & Medicaid Services (CMS), Office of the Inspector General, and other auditing entities are making post-acute care organizations jump through hoops to ensure the financial robustness of their operations.

Post-acute Care Claim Denials Amid Pandemic Chaos

The post-acute care financial landscape was treacherous enough before, and the pandemic has only made it more challenging to navigate for organizations across the nation. With organizations feeling the staffing shortage pinch due to vaccine mandates, burnouts, changing guidelines, and more, administrative tasks requiring manual, tedious labor are accumulating over months at a time. Claim denials and the resulting write-offs are the single most overlooked source of financial vulnerability for organizations both big & small. With an average denial rate across just the skilled nursing industry of 5%, operators stand to lose over $120,000 per facility in just write-offs each year.

The loss of revenue from just delayed or incomplete payments and write-offs are not easy to quantify and qualify and it builds up over time to plague the operations of post-acute care organizations. This is where technology like automation can aid the situation and help post-acute care organizations to prevent the financial drain from claim denials.

Enacting change through a digital workforce

Workflow automation solutions powered by Artificial Intelligence (AI) & Robotic Process Automation (RPA) are being utilized by early post-acute care adopters to increase reimbursements and reduce the cost to collect across the revenue cycle.

Denial Management Automation

Denial management automation is just one part of that ecosystem and can single handedly make a huge difference to the organization's revenue stream.

Trained software robots take care of the identification of denial codes and resolution with little to no manual intervention from the staff.

Clinical staff no longer need to scour through pages of the EOB to find the denial codes to begin resolution on the denied claim.

The denial automation solution automatically monitors & scans the clearinghouse for denials, importing the denial status, codes, and reason into the EHR. Furthermore, the solution also triggers the workflow for correction, notifying the relevant staff member required to perform the correction. All this before the 835 is even available for download.

Discover how Element5's Denial Management Automation streamlines your workflow.

Quite literally. With vendors like Element5, automation solutions built for post-acute care needs are now more easily accessible for deployment at minimal investment for exceptional, tangible returns. Moreover, the scalable nature of the technology allows post-acute care organizations of all sizes to benefit from it. The assurance of zero errors and a fatigue-free system ensure that denial write-offs can become a thing of the past. No more spending hours trying to find denial codes, no boring data entry tasks, and no lost revenue due to denials. Don't take our word for it, check all of it out in action here.