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Denials Analytics

KREG’s 835 Denials Analytics

KREG’s 835 Denials Analytics provides many ways for clients to identify, track and ultimately reduce denials. Our users view 835 data right next to the CMA calculation voucher to view all pertinent information related to any identified underpayments without having to refer to any other system.

The 835 information is reportable via 835 standard reporting as well as via filters on KREG’s drill down and claim tracking reports. By integrating 835’s into your contract management solution you will more efficiently follow up on underpayments, validate contract builds and improve cash flow. Reduced days in AR will also be achieved by identifying and correcting the root causes of your denials in a timelier manner.

The following reports illustrate how the 835 data can be used in your daily workflow.

In Report #1 we’ve used the drill down reporting capability for a report at the summary level of detail. It shows the top 10 payer's total number of denied claims for the top 5 denial codes for the current fiscal year. This is a multiple hospital system so you can see the number of denials by hospital and by payer. In addition, you can see the total charges, the expected payments and expected contractuals calculated for each claim by CMA as well as the total payments/contractuals received for these claims.

REPORT #1

kew denials report 1
In Report #2 we show the number of denials by reason code for the past month. This client is focusing on identifying and reducing the number of denials for N3 – Missing Consent Forms. As you can see, they had 36 claims totaling $341,483 for the period. Given the amount of reimbursement involved it is clearly worthwhile to change internal processes to make sure a Consent Form is obtained from the patients.

REPORT #2

kew denials report 2

In Report #3 you see the ability to have the Expected Payment Voucher calculated by CMA alongside the 835 for any claim. The entire claim, with an expected payment of $2,630, was denied for N3 – Missing Consent form. You see the 835 shows each line item on the claim being denied for the same reason.

REPORT #3

kew denials report 3

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