HBI Consulting brings a multidisplinary approach to the industry-wide problem of denials. Our approach is built from the ground up, informed by proven leading practices, from our research community of 1,800+ organizations, and with a cornerstone of sophisticated business intelligence. We coach and equip providers with the necessary skills and information to help them make fact-based decisions and achieve significant results.
90% of Providers Rank Denials Management as Priority #1
Results of HBI’s 2016 Revenue Cycle Leadership Survey of Top Priorities
On the Surface You See Defects
We think of denials as defects. They create cost through rework, deceleration of cash, and they often result in uncompensated care. Our definition of denials is intentionally broad. We believe anything that impedes (slows or stops) a claim from being reimbursed at 100% of the expected amount, without rework, should be treated as a denial.
Under the Surface are Root Causes
The most efficient way to reduce the amount of lost revenue is to target the root cause of disputed claims. Often, there is tremendous opportunity for hospitals and health systems to prevent yield loss with better visability into the root causes, using improved analytical solutions and business intelligence. Our framework provides an intelligent, holistic view of the root causes, quickly bringing the findings to the surface.
|3–5%||Yield loss due to denials|
|10–20%||Average rate of initial denials|
|50–70%||Denials are preventable|
|40–60%||Denials are never worked|
HBI’s Framework to Reduce and Avoid Disputed Claims
We use process excellence and business intelligence to systematically address denials at the root cause.
PHASE I—Define and Measure
- Competency Assessment
- Root Cause Account Audits
- Analytics on 835s, 837s, and More
- Denial Categorization
- Denial Segmentation
- Market Benchmarking
PHASE II—Analyze and Improve
- Onsite Assessment and Interviews
- Denial Mitigation
- Payer/Patient Strategies
- Market Research
- Contract Analysis/Reviews
- Ongoing Governance
- Business Intelligence and Analytics
- Daily Performance Tracking, Reporting, Alerts, and Workflow
Case Study: Deploying Custom Analytics to Reduce Denials and Increase Net Revenue
Through visibility into trends and concerted work on accountability, one organization increased authorized referrals in Oncology from 17% to 50%, which in turn reduced initial denials related to patient access root causes by 29%, equating to cash improvement of $5M. Over the past six months, Behavioral Health reduced the average monthly denial amount by 26% and increased yield cash by $314,672.
Why Healthcare Providers and Leaders are Approaching HBI Consulting for Help
We give you more visibility and insight into the data, and normalize what the information is saying to make everything understandable and actionable
We call on our foundation of research and best practices to draw the best insights from the market for your benefit
We minimize the drama associated with denials management by dispassionately applying data to a collaborative process of developing solutions
We teach people new skills about how to understand the part they play in the denial and revenue cycle ecosystem, and how to use data to solve problems