Challenge

Providers need to determine when there is a spike in denial rates or billing patterns to resolve potential issues before they impact their bottom line. They need a way to determine whether the spike is only occurring within their practice, whether their peers are also experiencing spikes, and if the same spike occurred in previous years. This information can help the practice better understand the spikes and how to address them.


Scenario

A provider, concerned about spikes in their denials, needed a way to trend service lines billed to a specific payer to ensure that there were no spikes in either the number of lines billed or the number of lines denied.


Solution

Comparative analytics can help providers trend billed service lines billed to a specific payer, helping identify and reduce spikes in billing and denials.

Through the use of RemitDATA’s comparative analytics solutions, practices can:

  • Configure two reports to trend both the total number of service lines billed for the practice and to trend the percent of denied service lines.
  • Configure the Remittance Dollar Overview to show the total number of service lines returned in the 835 over the last 12 months.
  • Trend against their own data for the previous 12 months to compare against the practice in the previous year(s).
  • Create a Denials Analysis report to show the percentage of denied service lines for the last 12 months. Using this report, practices can compare the data to state and national averages to see what the denial rates are for peers in the same specialty.

Download the Uncover Spikes in Denials or Billing Patterns PDF