In this episode, Olga Barone-Allan, BESLER’s Director of Revenue Integrity, provides us with a glimpse into BESLER’s next free webinar, Understanding Denials: Strategies for Improvement in the Revenue Cycle, presented live on Wednesday, June 4, at 1 PM ET.
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Learn how to listen to The Hospital Finance Podcast® on your mobile device.Highlights of this episode include:
- Why understanding the healthcare revenue cycle is important in understanding denials
- How denials are an important part in the revenue cycle process
- The definition of a denial
- How an organization can approach denials
- The impact regulatory changes have on denials
Kelly Wisness: Hi, this is Kelly Wisness. Welcome back to the award-winning Hospital Finance Podcast. We’re pleased to welcome back Olga Barone-Allan, BESLER’s Director of Revenue Integrity. In this episode, Olga will provide us with a glimpse into BESLER’s next free webinar, Understanding Denials: Strategies for Improvement in the Revenue Cycle, that we’re presenting live on Wednesday, June 4th at 1 PM Eastern Time. Welcome back, and thanks for joining us, Olga.
Olga Barone-Allan: Thank you, Kelly.
Kelly: Well, let’s jump in. Why is understanding the healthcare revenue cycle important in understanding denials?
Olga: That’s a great question. Each phase of the revenue cycle is designed to ensure that healthcare providers receive timely and accurate reimbursement for the services they provide while minimizing financial risk, reducing errors, and optimizing cash flow. Efficient management of the revenue cycle can significantly impact on the financial health of a healthcare organization. It’s so intricate, and there’s so many different departments involved, so to collaborate and to get everything needed on a bill is just very daunting. So, it’s very important to know each other’s area within a healthcare organization.
Kelly: No, that makes a lot of sense. So, denials have an important part in the revenue cycle process. Can you tell us a little bit more about that?
Olga: Absolutely. Denials are a thorn in everyone’s side. It’s always been. We all think over the years that we’re going to master this monster. Unfortunately, denials are here to stay. So, denials can have a significant impact on healthcare organizations, affecting revenue, patient care, and operational efficiency. The process of handling denials is time-consuming, costly, and can lead to financial instability, if not managed effectively. I’ll go over aspects of the detail to get a full understanding during the webinar. And this doesn’t just impact the healthcare organization. It also impacts the patients so that negative press or negative feedback from patients can impact the healthcare organization’s image.
Kelly: Yeah, it sounds like they really do have an important part there. So can you define for us what a denial is?
Olga: Sure. Denials refers to situations where an insurance claim is not paid or is only partially paid by the payer, the insurance company or government program, whoever the claim is being processed by. Denials can occur for various reasons. They have a direct impact on the healthcare provider’s revenue cycle, which involves all of the administrative and clinical functions that contribute to the capture, management, and collection of patient service revenue. We’ll go over some of the common reasons for denials. Some are very typical delay tactics I referred to that insurances play. Others are more involved and need to get other departments involved, medical records or encoding or clinical departments, to help satisfy the need of that denial– the reason for that denial. It’s a very time-consuming approach to resolve these denials, and that’s why a lot of times some healthcare organizations just don’t have the manpower to handle them.
Kelly: Yeah, I can imagine so. It sounds like they are quite significant. So how can an organization approach denials?
Olga: We’re going to be looking at two different ways of looking at denials. We’ll look at denials after they occur and then those being– trying to be proactive and trying to prevent them to occur at all. That’s always the best approach in looking at denials. Just looking at them afterwards doesn’t help the organization get the money any faster. So, by tackling them from the two different perspectives helps resolve the denials for a longer term, rather just for the quick fix.
Kelly: Yeah, that definitely sounds like a better approach, thinking about the long term and not just the short term. So yeah. So, what impact does regulatory changes have on denials? I’m sure it’s significant.
Olga: Yeah, I mean, healthcare is always changing, so the evolving healthcare regulations directly affects denial rates in various ways. From changing reimbursement rules, shifting coding guidelines, increasing payer scrutiny to regulatory acts like the No Surprise Act and Medicare, Medicaid policy adjustments. Healthcare providers must remain agile and proactive in adapting to those changes and always be aware of these changes quickly. Failing to do so could result in increased denials, financial losses, and compliance penalties.
Kelly: But the impact is crazy significant there.
Olga: Yes.
Kelly: So, what additional topics might you be talking about during this webinar?
Olga: The webinar will be talking about also just the types of denials that occur, how to approach them, some actions that you can do on your own. Also, we’ll have a recap of the key points of the webinar. And then, we’ll leave you with wanting to review your own denial management process to make sure that the areas that we point out are being addressed, and then we’ll leave some time for questions and answers.
Kelly: Sounds great. Well, thank you so much for joining us, Olga, and for sharing this sneak peek into the upcoming webinar, Understanding Denial: Strategies for Improvement in the Revenue Cycle, that we’re presenting live on Wednesday, June 4th at 1 PM Eastern Time. And as a bonus, you can earn CPE. Thanks again, Olga.
Olga: Thank you, Kelly.
Kelly: And thank you all for joining us for this episode of The Hospital Finance Podcast. Until next time…
[music] This concludes today’s episode of The Hospital Finance Podcast. For show notes and additional resources to help you protect and enhance revenue at your hospital, visit besler.com/podcasts. The Hospital Finance Podcast is a production of BESLER | SMART ABOUT REVENUE, TENACIOUS ABOUT RESULTS.
If you have a topic that you’d like us to discuss on the Hospital Finance podcast or if you’d like to be a guest, drop us a line at update@besler.com.
