Optimizing Operations and Learning From Denials

Even newcomers to healthcare finance know healthcare providers don't get paid for every claim submitted to third parties. CHCs are no different as they struggle to master straight Medicaid, Managed Care Entities (MCEs, both Medicaid and commercial), Medicare, and numerous commercial payers. Each has unique remittance advice (RAs), Explanation of Benefits (EOBs), and sometimes seemingly senseless (almost endless) denial or suspense reason codes. Attend this program to learn how you can garner powerful knowledge from denial data. Hear how it's possible to find the source of denials by identifying patterns within your denial data. For example, how many are front desk issues (e.g., eligibility or demographic), clinic operations (e.g., coding or prior authorizations), or issues with credentialing? Understanding how to recognize and act on this information can have a powerful impact on your CHC's bottom line.

• Understand what an 835 file is and why a CHC wants tp receive as many ERAs as possible.
• Correlate denials to related clinic operational tasks.
• Understand possible tracking options and how to maximize vendor (e.g., clearinghouse) data.