Percentage of Recurring Denials

Percentage of Recurring Denials is a key metric in healthcare revenue cycle management that measures the percentage of denied claims that are repeatedly denied after being resubmitted. This metric is important because it helps healthcare organizations identify patterns in their denial management process and take corrective action to reduce the number of recurring denials. By tracking the percentage of recurring denials, healthcare organizations can identify the root causes of denials, such as coding errors or incomplete documentation, and implement strategies to address these issues. Ultimately, reducing the percentage of recurring denials can improve the financial health of healthcare organizations by increasing revenue and reducing administrative costs associated with denied claims.

Percentage of Recurring Denials is calculated by dividing the number of denied claims that have been previously denied and resubmitted by the total number of denied claims. This metric helps healthcare organizations identify patterns in denials and take proactive measures to prevent them from recurring.

To calculate this metric, first, identify the total number of denied claims during a specific period. Then, determine the number of denied claims that have been previously denied and resubmitted during the same period. Finally, divide the number of recurring denials by the total number of denied claims and multiply the result by 100 to get the percentage of recurring denials.

For example, if there were 100 denied claims during a month, and 20 of them were recurring denials, the percentage of recurring denials would be 20%.

Best practices to improve Percentage of Recurring Denials are:

1. Analyze the root cause of denials: To reduce recurring denials, it is essential to identify the root cause of the denials. Analyzing the reasons for denials can help healthcare organizations to implement corrective measures to prevent them from happening again.

2. Implement a denial management program: A denial management program can help healthcare organizations to track and manage denials effectively. The program should include a process for identifying, appealing, and resolving denials.

3. Educate staff on denial prevention: Healthcare organizations should educate their staff on the importance of preventing denials. Staff should be trained on the proper coding and billing practices to avoid errors that can lead to denials.

4. Use technology to automate processes: Healthcare organizations can use technology to automate processes such as claims submission and follow-up. Automation can help to reduce errors and improve efficiency, which can lead to a reduction in denials.

5. Monitor and track denial trends: Healthcare organizations should monitor and track denial trends to identify recurring denials. This can help to identify areas for improvement and implement corrective measures.

6. Establish a denial prevention team: Healthcare organizations should establish a denial prevention team to oversee the denial management program. The team should be responsible for identifying and implementing strategies to prevent denials.

7. Collaborate with payers: Healthcare organizations should collaborate with payers to understand their denial policies and procedures. This can help to reduce denials and improve the overall revenue cycle management process.

The industry standard benchmark for Percentage of Recurring Denials is typically set at 5% or lower. This means that providers should aim to have no more than 5% of their claims denied and subsequently resubmitted. A higher percentage of recurring denials can indicate issues with the provider's billing and coding practices, as well as potential problems with payer contracts and policies.

To calculate the Percentage of Recurring Denials, providers should divide the number of claims that are denied and subsequently resubmitted by the total number of claims submitted during a given period, such as a month or quarter. This metric can be tracked over time to monitor trends and identify areas for improvement.

Providers can improve their Percentage of Recurring Denials by implementing effective denial management processes, such as timely follow-up on denied claims, accurate billing and coding practices, and regular monitoring of payer policies and contracts. By achieving a low Percentage of Recurring Denials, providers can improve their revenue cycle performance and ensure timely reimbursement for services rendered.

Revenue cycle software can significantly improve the Percentage of Recurring Denials metric by providing real-time data and analytics that help identify the root causes of denials. With this information, healthcare organizations can implement targeted solutions to prevent future denials, reduce the number of appeals, and ultimately improve their revenue cycle performance.

MD Clarity's revenue cycle software is designed to streamline the entire revenue cycle process, from patient registration to claims submission and payment posting. Our software features advanced analytics and reporting capabilities that provide insights into the denials management process, allowing healthcare organizations to identify trends and patterns in denials and take proactive measures to prevent them.

If you're looking to improve your Percentage of Recurring Denials metric and optimize your revenue cycle performance, we invite you to book a demo with MD Clarity today. Our team of experts will walk you through our software and show you firsthand how it can help you reduce denials, increase revenue, and improve your bottom line.