Hayes Expert Explores the Root Causes of Climbing Claims Denials Rates and Performance Improvement Solutions at AHIMA21

Posted in Press Releases on Monday, September 20, 2021.

Hayes Expert Explores the Root Causes of Climbing Claims Denials Rates and Performance Improvement Solutions at AHIMA21

Wellesley, MA — September 20, 2021 — Hayes, makers of the industry’s leading integrated auditing, billing compliance and revenue integrity platform for the nation’s premier healthcare organizations, announced today that Vasilios Nassiopoulos, CPC, CCO, will present Leveraging Denial Trends to Identify Risks and Prevent Audits at the AHIMA21 Virtual Conference. The presentation, which explores the catalyst behind rising claims denials and how healthcare organizations can reverse the trend, takes place on Sept. 22 at 11:45 a.m. ET.

“Denied claims have been increasing steadily over the past three years, an upward trajectory that is accelerating in the wake of the COVID-19 pandemic,” said Nassiopoulos, Hayes’ vice president of platform strategy and innovation. “Our own analysis of Hayes’ client organizations, who have experienced denials totaling $24 billion, found that 18% of rejected claims were related to billing compliance and 40% of COVID-19 claims continue to be rejected due to bundling issues. The good news is that understanding what is driving the denial trend lets us design effective strategies to turn it around – before lasting damage is done to an organization’s bottom line.”

During his presentation at AHIMA21 Virtual Conference, Nassiopoulos will share an in-depth breakdown by reason for denials that delves into specific details by case, procedure and diagnosis based on a proprietary analysis of catastrophic claims related to COVID-19, pharmaceutical pricing, bioidentical alternatives, DME utilization and telehealth. He also examines why and how to establish proactive denial trends and monitoring practices – including categorizing denials based on root cause and compliance-related Claims Adjustment Reason Codes (CARCS) – to insulate compliance programs from external audits due to repeated billing errors.

“I’ll also provide insights into the importance of maintaining close and continuous collaboration between revenue cycle, HIM, revenue integrity and compliance teams, and share methods for integrating such communications into the workflow,” said Nassiopoulos. “By providing a peek behind the curtain of third-party denial flags and other issues driving denials, which go far deeper than widely publicized edits, we can empower compliance and billing teams to create a roadmap to eliminate avoidable denials from the revenue cycle and keep them from negatively impacting revenue integrity.”

MDaudit Enterprise from Hayes is a powerful auditing, integrity, and analytics platform that addresses an organization’s comprehensive billing compliance and revenue integrity needs, enabling prospective and retrospective audits and providing insights into denied claims. Watch this informative video to learn more about the market forces that are reshaping the revenue integrity landscape and how MDaudit Enterprise addresses them.

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About Hayes and MDaudit

Hayes is a leading healthcare technology provider that partners with the nation’s premier healthcare organizations to improve revenue, mitigate risk and reduce operating costs to succeed in an evolving healthcare landscape. MDaudit Enterprise, our flagship revenue integrity SaaS platform, enables organizations to reduce compliance risk, improve efficiency and retain more of their revenue stream by providing workflow automation, risk monitoring, and built-in analytics and benchmarking capabilities – all in a single, integrated cloud-based platform. To learn more visit www.hayesmanagement.com.

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