Average Time to Resolve Claim Denials is a key metric in healthcare revenue cycle management that measures the average amount of time it takes for a healthcare organization to resolve a claim denial. Claim denials occur when a healthcare payer rejects a claim submitted by a healthcare provider for payment. The reasons for claim denials can vary, but they often result from errors in coding, incomplete or missing information, or lack of medical necessity.
The Average Time to Resolve Claim Denials metric is important because it provides insight into the efficiency of a healthcare organization's revenue cycle management process. A longer average time to resolve claim denials can indicate that there are issues with the organization's claims submission process, such as errors in coding or incomplete information. This can lead to delayed payments and negatively impact the organization's cash flow.
Average Time to Resolve Claim Denials is calculated by dividing the total number of days it takes to resolve all claim denials by the total number of claim denials resolved during a specific period.
To calculate this metric, you need to track the date when the denial was received and the date when it was resolved. The time taken to resolve a claim denial includes the time taken to identify the reason for the denial, gather additional information, and resubmit the claim. Once you have this data, you can calculate the average time to resolve claim denials by dividing the total number of days taken to resolve all claim denials by the total number of claim denials resolved.
This metric can help healthcare organizations identify areas where they can improve their revenue cycle management processes and reduce the time and resources required to resolve claim denials.
Best practices to improve Average Time to Resolve Claim Denials are:
1. Identify the root cause of claim denials: The first step to reducing the average time to resolve claim denials is to identify the root cause of the denials. This can be done by analyzing the data and identifying the most common reasons for claim denials.
2. Implement a denial management process: A denial management process should be implemented to ensure that all denied claims are tracked, analyzed, and resolved in a timely manner. This process should include clear guidelines for staff on how to handle denied claims, as well as a system for tracking and reporting on the status of each claim.
3. Train staff on best practices: Staff should be trained on best practices for resolving claim denials, including how to identify the root cause of the denial, how to appeal denied claims, and how to communicate with payers.
4. Use technology to streamline the process: Technology can be used to streamline the process of resolving claim denials. This can include using automated workflows to track and manage denied claims, as well as using analytics tools to identify trends and patterns in claim denials.
5. Monitor and measure performance: Regular monitoring and measurement of performance is essential to improving the average time to resolve claim denials. This can include tracking key metrics such as denial rates, average time to resolve denials, and the number of appeals filed.
By following these best practices, healthcare organizations can improve their average time to resolve claim denials, reduce costs, and improve overall revenue cycle management.
The industry standard benchmark for Average Time to Resolve Claim Denials is 30 days. This means that healthcare organizations should aim to resolve claim denials within 30 days of receiving them. This benchmark is important because it helps healthcare organizations to identify areas where they can improve their revenue cycle management processes.
If a healthcare organization takes longer than 30 days to resolve claim denials, it can have a negative impact on their revenue cycle. This is because the longer it takes to resolve a claim denial, the longer it takes to receive payment for the services provided. This can lead to cash flow issues and can also increase the risk of bad debt.To improve their Average Time to Resolve Claim Denials, healthcare organizations should focus on identifying the root cause of the denials and implementing processes to prevent them from occurring in the future. They should also ensure that they have a dedicated team responsible for resolving claim denials and that they have access to the necessary resources and technology to do so efficiently.
In conclusion, the industry standard benchmark for Average Time to Resolve Claim Denials is 30 days. Healthcare organizations should aim to meet or exceed this benchmark to ensure a healthy revenue cycle and avoid cash flow issues.
Revenue cycle software can significantly improve the Average Time to Resolve Claim Denials metric by automating the claims management process. With the help of advanced analytics and machine learning algorithms, revenue cycle software can identify the root cause of claim denials and provide actionable insights to resolve them quickly.
By automating the claims management process, revenue cycle software can reduce the manual effort required to resolve claim denials, which in turn reduces the time taken to resolve them. This leads to a significant improvement in the Average Time to Resolve Claim Denials metric, which is a critical metric for healthcare providers.
If you're looking to improve your revenue cycle management and reduce the Average Time to Resolve Claim Denials metric, then it's time to consider MD Clarity's revenue cycle software. Our software is designed to streamline the claims management process and provide actionable insights to resolve claim denials quickly. Book a demo today to see firsthand how our software can improve your revenue cycle management.