In a recent post, we looked at how hospital denial rates are exceeding "denials danger zone'' of 10%. Fierce Healthcare reports the following from its survey:
- 33% of the poll’s respondents reported average denial rate exceeding the “denials danger zone” of 10%
- 16% of the poll’s respondents reported average denial rate between 8% and 10%
- 22% of the poll’s respondents reported average denial rate between 5% and 7%
- 31% of the poll’s respondents reported average denial rate was below 5%
The results from the survey provide a small sample of the rise in denied claims, with responding hospitals (69%) exceeding the targeted denial rate between 2%-4%.
Categorization for Correspondence Letters
Over the past year, our R&D team has delivered many enhancements to our OrboAccess and Healthcare Payments Automation Center (HPAC) technology. One of the major enhancements offers the ability for users/clients to custom categorize correspondence letters -- improving the efficiency of working denials.
For the past several years, OrboAccess would assign a correspondence letter to one of thirteen distinct categories:
- Additional Information Requested
- Appeal Response
- Bill Denied
- Bill Under Review
- Legal Correspondence
- No Record of Patient
- Prior Authorization
- Refund Request
- Return to Sender – Unknown Address
- Tax Forms
- Other Correspondence
In June 2021, we introduced a major feature enhancement for the categorization of correspondence letters. Clients/user feedback indicated that they would like more flexibility in expanding the number of categories, as some clients have unique naming conventions.
Through the process of electronification -- leveraging our OrbNet AI technologies -- users/clients with administrative permissions have the ability to create and customize their categories for their account. The admin can then assign "key phrases" as identifiers to these categories. As correspondence letters are being processed by our technology, the system will search through the documents to locate "key phrases" and automatically categorize each letter.
Additionally, we added a feature that identifies correspondence claims that are part of the same letter and automatically-generates a unique icon when a search is run. Items that share the same source letter will have the same icon.
This automatic categorization, in combination with our Workflow Management feature, allows users/clients to easily identify the category of any correspondence letter and work the denied claims accordingly.