Introduction:
Reducing Claim denials for this DME provider’s resources, slowing cash flow, and overburdening their staff. But by implementing strategic process improvements and leveraging modern technology, they cut their denial rate in half.
This case study walks through the challenges they faced, the steps they took to improve their claims process, and the impressive results they achieved.
The Challenge
Before implementing changes, the provider faced:
- High Denial Rates: Nearly 25% of claims were denied due to missing documentation, coding errors, and eligibility issues.
- Time-Consuming Rework: Staff spent hours each week correcting and resubmitting claims, reducing productivity.
- Inconsistent Workflows: Lack of standardized procedures led to repeated errors and inefficiencies.
These issues caused delays in payments, strained staff morale, and left patients dissatisfied.
The Solution
To address these challenges, the provider focused on three key areas:
- Automating Eligibility Verification
- Implemented a tool to verify patient insurance in real-time, reducing eligibility-related denials by 40%.
- Streamlining Documentation Collection
- Created a digital checklist for patients and staff to ensure all required documents, like prior authorizations, were submitted before claims submission.
- Enabled an online portal for easy document uploads.
- Adopting Claims Management Technology
- Used a centralized platform to track claims, detect errors, and generate reports on denial trends.
- Standardized workflows to ensure all staff followed the same process.
The Results
The provider saw dramatic improvements within six months:
- 50% Reduction in Claim Denials: Automated tools and clear processes minimized common errors.
- 30% Faster Claim Resolutions: Real-time eligibility checks and streamlined workflows reduced processing time.
- Increased Staff Efficiency: Employees spent less time on rework and more on high-value tasks like patient care.
- Higher Patient Satisfaction: Reduced delays in equipment delivery improved the overall patient experience.
Lessons Learned
- Invest in Automation: Technology plays a critical role in reducing errors and speeding up claims processing.
- Focus on Communication: Clear communication with patients and staff prevents documentation gaps.
- Analyze Denial Trends: Regularly review denial data to identify recurring issues and implement targeted solutions.
WWS Value Proposition
This provider’s success is a testament to the power of WWS’s solutions. From automation tools to customized claims workflows, we help DME providers reduce denials, improve efficiency, and enhance patient satisfaction.
Ready to transform your claims process? Let WWS guide your journey to better results.
