Analytics to Reduce Denials

As medical denial rates continue to increase, so does the importance for revenue cycle teams to pinpoint trends and gaps with analytics.

By:  Randal Wynn

The COVID-19 pandemic has had a tremendous impact on healthcare over the past few years.  One area impacted is hospital claims denial rates.  According to Healthcare Finance, denials have increased 20% over the past five years.  Since the onset of the pandemic, denials have increased even more.  In fact, 33% of hospitals have an average 10% or more denial rate.  To reduce the number of claims denials, processes must be assessed and analytics utilized to achieve improvement.

How JTS’ Analytics Can Help Reduce Denials

As medical denial rates continue to increase, so does the importance for revenue cycle teams to determine areas of opportunity. JTS’ nCREAS™ analytics to reduce denials identifies trends and gaps based on 835 remittance data, which is crucial for successful management.  This platform provides analysis of denial rates based on services by location and by payor with predictive and prescriptive analytics representing total expected reimbursement outcomes given current patterns.  In addition, it monitors cash and denial data and creates a historical log of both metrics. nCREAS™ assists to drive profitability by generating insights into areas requiring focus.

What Makes JTS’ Analytics to Reduce Denials Unique

Using JTS’ nCREAS™ analytics to reduce denials is unique because we work directly with a facility to categorize each denial type based on code. JTS has a standard assignment, but we know each facility is distinct and could be set up differently.  One of the biggest pain points JTS has found is that denials were caused because they were not being worked when the claim was received back.  JTS’ nCREAS™ analytics is effective in reducing denials by categorizing denials by department to determine volume, dollars and rate. It examines historical recovery rate by denial code and department, as well identifies potential recovery opportunities. nCREAS™ also enables pinpointing of denials remaining untouched.

All data inside nCREAS™ denials management reports prescriptively identify the action by drilling down through our hierarchy levels to a single account number.