Earlier this week, Paula Roth, VP of Infusion Operations at Prochant, and Rachel Ewell, Director of Payer Contracts at Amerita, joined NHIA for a timely and tactical webinar focused on managing and preventing denials in the infusion space.
The session explored denials from both the front-end and back-end perspectives, offering a deep dive into the most common denials facing infusion providers today and the root causes behind them. Paula and Rachel emphasized the importance of tracking denial trends over time, not just to monitor performance, but to uncover systemic issues and course-correct before they impact revenue.
Top 4 Takeaways:
- Working denials starts with smart prioritization and categorization. Not all denials are created equal. Paula and Rachel emphasized that effectively working denials begins by categorizing them based on factors like dollar value, denial reason and payer. This approach ensures teams are focusing their efforts where they’ll have the greatest financial impact.
- Treat denials as a continuous feedback loop. The speakers highlighted the value of bringing together cross-functional teams, from RCM to pharmacy, to review denials data regularly. These insights can point to needed fixes in systems, workflows or training, helping to prevent future denials.
- Prevention starts with the right tools and tactics. From addressing the top five denial types to implementing claim scrubbing and denial prediction tools, automation and AI are playing an increasingly important role in helping providers reduce denials and submit cleaner claims.
- Clean claims are the goal – even if denials are inevitable. While some denials can’t be avoided, having the right processes, technology and team alignment in place can significantly reduce their frequency and improve overall revenue cycle performance.
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