Many hospitals have not installed claims denial management tools, HIMSS survey shows

More than half of hospital executives recently surveyed by HIMSS Analytics said their facilities currently don’t use vendor claims denials management software. However, that could change fast as providers face an urgent need to optimize revenue while moving toward value-based reimbursement models.

The survey found that only 44 percent of responding hospitals say they use a vendor solution, with 31 percent relying on manual processes, 18 percent deploying an internally developed system, and 7 percent not even sure what they use (talk about a red flag).

But the survey also revealed that 60 percent of the respondents who now lack a vendor denials claims management solution plan to purchase one in the next seven to 12 months.

Healthcare IT News Editor-in-Chief Tom Sullivan writes, “That means the industry is essentially on the cusp of all providers needing a modern and effective way to handle denied claims in lockstep with the transition to value-based care and, to a lesser extent, the upcoming Oct. 1, 2106 date after which the Centers for Medicare and Medicaid Services is poised to demand greater specificity in claims submitted using ICD-10 codes.”

Requiring more precise coding under ICD-10 could lead to an uptick in denials for some hospitals when they can least afford it. That’s why, experts say, the time to prepare is now.

"Leading up to the changeover to value-based care, healthcare organizations should focus on fine-tuning the process of claims denials," said Brendan FitzGerald, Research Director for Advisory Solutions at HIMSS Analytics. "There's opportunity for both vendors and hospitals to really dial-in these processes."

In addition to claims denials management software, hospitals can use analytics to reduce denials. 

"The change from a fee-for-service system to value-based care is not going to occur overnight," Fitzgerald said. "In the meantime, healthcare organizations need to ensure their revenue streams are protected."

Related article: Focusing on these 3 things can help providers prevent claims denials



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