Technical Denial Rate

Technical Denial Rate is a key metric in healthcare revenue cycle management that measures the percentage of claims that are denied due to technical errors such as missing or incorrect information, coding errors, or formatting issues. These denials are not related to the medical necessity or appropriateness of the services provided, but rather to administrative errors in the billing process. Technical Denial Rate is an important metric because it can indicate areas where improvements can be made in the billing process, such as staff training, process improvements, or technology upgrades. By reducing the Technical Denial Rate, healthcare organizations can improve their revenue cycle performance and increase their overall financial health.

Technical Denial Rate is calculated by dividing the total number of denied claims due to technical errors by the total number of claims submitted during a specific period of time. Technical errors can include issues such as missing or incorrect patient information, invalid procedure codes, or incomplete documentation. The resulting percentage represents the rate at which claims are denied for technical reasons, which can provide insight into the effectiveness of a healthcare organization's billing and coding processes.

Best practices to improve Technical Denial Rate are:

1. Conduct a root cause analysis: The first step to improving technical denial rate is to identify the root cause of the denials. Analyze the data to determine the most common reasons for technical denials and develop a plan to address them.

2. Implement automated processes: Automating processes can help reduce the likelihood of technical denials. Implementing automated processes such as electronic claim submission and automated claim scrubbing can help reduce errors and improve accuracy.

3. Train staff: Staff training is essential to reducing technical denials. Ensure that staff members are trained on the latest coding and billing guidelines, as well as the use of technology and software.

4. Monitor and track denials: Monitoring and tracking denials can help identify trends and patterns. Use data analytics to identify the most common reasons for technical denials and develop strategies to address them.

5. Improve documentation: Accurate and complete documentation is critical to reducing technical denials. Ensure that documentation is clear, concise, and meets all coding and billing guidelines.

6. Implement a denial management program: A denial management program can help reduce technical denials by identifying and addressing issues before they become denials. Develop a program that includes regular audits, staff training, and process improvements.

7. Collaborate with payers: Collaborating with payers can help reduce technical denials. Work with payers to understand their requirements and develop processes that meet their needs.By implementing these best practices, healthcare organizations can improve their technical denial rate and reduce the financial impact of denials.

The industry standard benchmark for Technical Denial Rate is typically set at 5% or lower. This means that healthcare organizations should aim to keep their Technical Denial Rate at or below 5% to ensure optimal revenue cycle management.

To achieve this benchmark, healthcare organizations should implement effective processes and systems to ensure accurate and complete documentation, coding, and billing. This may include regular training and education for staff, utilizing technology such as automated coding and billing software, and conducting regular audits to identify and address potential issues.

By keeping their Technical Denial Rate at or below the industry standard benchmark, healthcare organizations can improve their revenue cycle management, reduce costs associated with denied claims, and ultimately provide better care for their patients.

Revenue cycle software can significantly improve the Technical Denial Rate metric by automating the process of identifying and resolving technical denials. With the help of advanced algorithms and machine learning, revenue cycle software can quickly identify the root cause of technical denials and provide actionable insights to resolve them.

By automating the process, revenue cycle software can significantly reduce the time and effort required to resolve technical denials, resulting in a lower Technical Denial Rate. Additionally, revenue cycle software can provide real-time visibility into the status of technical denials, enabling healthcare organizations to proactively address issues and prevent future denials.

If you're looking to improve your Technical Denial Rate metric, it's time to consider implementing revenue cycle software. MD Clarity's revenue cycle software is designed to help healthcare organizations streamline their revenue cycle management processes and improve their financial performance. Book a demo today to see firsthand how MD Clarity's revenue cycle software can help you improve your Technical Denial Rate metric and achieve better financial outcomes.