What is keeping revenue cycle leaders from feeling more effective at denials management? Amanada de los Reyes, VP of Revenue Cycle at Valleywise Health, describes top stressors.
Research shows denials teams are struggling with feeling effective. Why do you think that might be?
Amanda de los Reyes "I think it's because it's like playing Whack-a-Mole with denials for providers. It seems like you just resolve one issue and then another issue pops up, which is really difficult.
“And sometimes one of the issues that you've resolved will lead to a different type of denial. So the best strategy is going to be prevention. We usually try to get to the root cause of what we're looking for and make a determination. And then that's when sometimes we find out that whatever we resolved for initially will turn into something else that also requires a solution. So it's really difficult.
“The other thing is that payers are making a lot of changes with their clearinghouses right now that they're using on their end. And often they're not letting the providers know. And I had that recently crop up a few times. We didn't know they made a change and started getting rejections for an invalid birth date. We looked at the claims and, of course, we had the birth date correct on the claims. And it took almost a month for the payer to be able to respond and figure out what was wrong on their end. And it was impacting a lot of providers. So just simple things like that.
"And I think the claims are getting more complex that we're sending across as well. And so often there's, you know, a lot of different denial reasons that can come across from one claim, especially on a high dollar account. And sometimes it's difficult to really understand what the payer is denying from their work and CARC code."
