Implementing a Denial Management Program: Step-by-Step Checklist

Claims denial management is an essential part of any healthcare practice. It’s vital for sustained cash flow but also for ensuring patient care is prioritized, preventing delays in treatment journeys. When claims are denied, patients either have to wait for care while appeals are ongoing, or practices must write off the costs so care is not delayed and patient outcomes are prioritized. 

NextGen electronic healthcare record (EHR) tools enable effective denial tracking, helping practice administrators log appeals fast or address workflow discrepancies that could be causing increased denials. 

Take a look at this guide to denial management, including a handy checklist for creating a structured, impactful denial management program for your practice. 

What Is Denial Management?

Most patients rely on healthcare plans and insurance to cover some or all of the costs of their treatment. When claims are accepted, the payments are made, and patient journeys move along smoothly. Claims denials can either leave practices out of pocket or cause preventable delays to patient treatment plans.

Effective denial management includes the assessment of claims denial rates and strategies to reduce those figures, increasing cash flow into the practice. Importantly, a lower denial rate improves the reputation of your practice and improves patient outcomes.

Implementing a practice-wide denial management plan is an effective way to boost revenue cycle performance. It can also contribute to enhanced regulatory compliance via clearer, more accurate documentation and reporting. 

Key Benefits of a Structured Denial Management Program

Practice managers may wonder what the benefits are of creating and implementing a structured claims denial plan versus dealing with denials via an ad hoc approach. The most obvious benefit is that when you’re proactively addressing the root causes of denials, your practice is more likely to experience faster payments and sustained cash flow. More money coming into your practice allows you to invest in improvements. You might spend additional budget on staff training to reduce billing errors and improve systems knowledge, creating a positive cycle of claims acceptance.

Denial management programs also help cut the amount of money practices have to write off each year. The American Hospital Association states that between the years 2000 and 2022, hospitals wrote off an astonishing $745 billion in uncompensated healthcare. Working to optimize patient care workflows and reduce billing errors could ensure that your practice is contributing as little as possible to that figure. 

Data siloes and poorly integrated systems are a major contributor to claim denial rates. Working with expert partners to ensure workflows are optimized across your practice management tools could be a major factor in reducing your denial rate and improving the profitability of your practice. 

Step-by-Step Checklist: How to Implement in NextGen HER

Ensure all these steps are covered in your claims denial management programs:

• Assess current denial rates and analyze root causes

• Align revenue cycle KPIs and reporting

• Configure NextGen workflows for denial tracking

• Develop internal processes for appeals and corrections

• Train staff on best practices and accountability

• Monitor denial trends using real-time dashboards and reports

Remember to tailor your reports for effective monitoring of improvements. You need to take a baseline denial rate and note improvements, month by month. If the improvement rate dips, quickly take action to understand what was different that month. You may find that additional personnel training is required, or that an increase in certain health conditions means a template needs tweaking to become fully effective. 

Real-World Tips: NextGen EHR Workflow Optimization for Denials

Your NextGen EHR and EPM workflows are a critical step in reducing claims denials. From the moment a clinician logs an initial patient interaction to the end of the treatment journey, every step can contribute to accepted claims.

Automation helps capture the relevant details that insurance claims administrators require. Custom templates, such as those tailored to your practice’s specialism, can also help. When clinicians are prompted at every stage to fill a field in before saving a patient record, it prevents lost data or missed details that could slow claim acceptance.

It’s also essential to have access to accurate reports. When you understand the claim denial rate, you can better address the root causes. The TempDev NextGen EHR Quality Dashboard is an intuitive tool for evaluating provider performance. Work with expert consultants to tailor your dashboard to your practice’s requirements, then combine it with effective reporting tools for continuous insights into claims acceptance and denial rates.

Practices can leverage this data for continuous improvement. Many claims are completely preventable and caused by in-practice mistakes, including:

• Incorrect data capture

• Patient detail mismatches

• Billing and coding errors

• Lack of prior authorization

• Missing supportive documentation, e.g., lab test results

Noting common causes of denials helps practices make changes that genuinely create positive, long-term impacts. Managers or administrators should liaise with all areas of the practice, from the front office to the IT teams. Gaining insights from everyone is critical to a holistic understanding of the scope of the current state of claims denials. This cross-functional collaboration also allows you to roll out effective staff training and encourage continuous learning practices.

How TempDev Helps

TempDev’s team of NextGen consultants can help you optimize your EHR and EPM systems for better claims denial management and improved revenue cycle management. Customized workflow and reporting solutions ensure that your denial management program is tailored to your practice and specialism.

Our consultants can help you find quick wins, such as smart NextGen workflow optimizations, and focus on the revenue cycle KPIs and benchmarks that will bring the biggest impact to your practice. We’ll also help you create templates and workflows that ensure compliance with the relevant regulatory requirements for your healthcare focus. 

Contact TempDev to book a NextGen EHR/EPM workflow assessment, or download our denial management program checklist. You can also speak to us about a consultation on leveraging NextGen tools to further optimize your revenue cycle. Improve your NextGen EHR and Practice Management tool implementation: all 1.888.TEMPDEV or get in touch online.