Reducing Denials

reducing denialsDenials are a concern for every provider and institution. Denials stress every aspect of revenue cycle management as they eat away at the bottom line, stress cash flow, and subsequent operations, and drain and entangle administrative, clinical, and financial resources during appeals. IMO has the tools you need to aid in reducing denials.

Some estimates suggest that as much as 9% of claims are denied annually and with ~$3.6 Trillion in spending in 2018, ~$324 billion in claims were denied, initially. Fortunately, 63% of claims that were denied were recovered, but not without a cost.¹,²

A closer look at the causes for denials, suggests that missing or invalid claim data and medical coding accounted for 20% of denials.¹ Without a doubt, these mid-cycle and back end processes are critical components to efficient revenue cycle management. 

We understand how important it is for practice managers to align clinical descriptions documented at the point of care to the correct ICD-10CM codes to ensure accurate coding and appropriate reimbursement. 

IMO knows how challenging it can be to translate diagnoses documented in a provider’s clinical language to the appropriate ICD-10CM codes, especially when code sets change. 

Furthermore, we understand the risk to the bottom-line if diagnoses are not accurately captured when they are transferred between systems.

To help our customers tackle coding challenges, simplify their workflow, and manage risk, we developed IMO Core, our industry-leading clinical interface terminology.  

IMO Core can help billing and coding professionals streamline the process of transferring diagnoses and codes from the billing summary or EHR into the practice management system. Additionally, IMO Core helps maintain the clinical, diagnostic, and coding integrity of claims that originate from a different EHR system to help billing and coding professionals easily navigate through interoperability challenges. 

With IMO Core you can:  

Document more credibly

  • Maximize reimbursement by easily capturing secondary conditions
  • Reduce denied claims with accurate, specific diagnosis terminology
  • Increase Medicare Advantage reimbursement by identifying all HCC diagnoses and codes

 

Operate more efficiently

  • Quickly and accurately find and document diagnoses that are mapped to appropriate codes
  • Save time with diagnoses and codes that are automatically updated by IMO subject matter experts (SMEs)
  • Ensure accurate billing and coding with maintenance-free terminology that is always current 

 

About Intelligent Medical Objects

At IMO, we are dedicated to powering care as you intended, through a platform that is intelligent, intuitive, and intentional. Used by more than 4,500 hospitals and 500,000 physicians daily, IMO’s clinical interface terminology (CIT) forms the foundation for healthcare enterprise needs including effective management of EHR problem lists, accurate documentation, and the mapping of over 2.4 million clinician-friendly terms across 24 different code systems. 

We offer a portfolio of products that includes terminologies and value sets that are clinically vetted, always current, and maintenance-free. This aligns with provider organizations’ missions, EHR platforms’ inherent power, and the evolving vision of the healthcare industry while ensuring accurate care documentation and administrative codes. So, clinicians can get back to being clinicians, health systems can get reimbursed, and patients can more easily engage in their own care. As intended.

To learn more please contact Will Caldwell or visit: https://www.imohealth.com/schedule-a-demo/

  1. https://www.changehealthcare.com/blog/wp-content/uploads/Change-Healthcare-Healthy-Hospital-Denials-Index.pdf
  2. https://www.meddata.com/blog/2017/10/26/medical-billing-statistics/

 

If you enjoyed this piece about reducing denials, be sure to read more informative articles from EZClaim and our partners.