Claim rejections and claim denials create considerable financial burden for US hospitals and health systems. Despite new revenue cycle technology, managing these denials remains a costly and time-consuming endeavor. Many organizations simply walk away, choosing not to correct, resubmit, or appeal. The result? Millions of rightfully earned provider dollars are left in the pockets of Medicare and third-party payers.
Certainly, a smarter strategy is to avoid losses associated with denied inpatient claims by increasing the percentage of claims approved in the first place. Investments in people, processes, and technology to prevent denials are far more effective than dollars spent on managing them. As hospitals and health systems pivot from denial management to denial prevention, inpatient prebill audits have reemerged as an effective reimbursement retention strategy.
But in the ICD-10 era, how effective are prebill audits? Formerly considered too significant a delay on discharged not final billed (DNFB), today’s prebill audits are making new inroads into HIM and revenue cycle workflows. In fact, proactive audits have become an important practice for ensuring accurate and timely reimbursement.