Denials Management July 8, 2015

Agenda The Cost of Denials Denials are growing Most denials are appealable Prevention is the Best Medicine Types of Denials Source of Errors Leading to Denials To Insource or Outsource MedPerformance iMAD 2

The Cost of Denials Your hospital is most likely losing around 3% of its net revenue due to denials – How much is 3% of your net revenue? – How much does that change your net income? You owe it to your organization to effectively manage denials The cost to collect is growing too 3

Denials are growing Many of the plans offered by certain payors reject about one in five claims Gross charges denied by payers have grown to an alarming rate Your reimbursement is not increasing enough to offset denials 4

Most denials are appealable – Recent estimates are around 67% You need to put a strong appeals process in place You need to research, investigate, and appeal denials You need a system to track, trend, and follow-up 5

Prevention is the Best Medicine 90% of denials are preventable Once we put in a denial management system, we were able to start tracking our denials. We realized that we were a huge part of the problem. It was not all the payers’ fault. We realized we needed to get our act together before we starting blaming the payors. – Quote from a hospital CFO 6

Types of Denials 23% - Medical Necessity 25% - Eligibility 19% - Authorizations 33% - Demographic Information 7

Source of Errors Leading to Denials 51% - Private Insurance 30% - Medicare 16% - Medicaid 3% - Other 71% - Outpatient 29% - Inpatient 8

To Insource or Outsource The Shortcomings of insourcing as the Sole Denial Management Strategy – Internal denial teams have proved generally successful – Experience shows they overturn, on average, a bit less than 50% of all denials – roughly 67% of all denials are appealable, nearer two of every three referred denials, so not performing as expected – Denials is a labor-intense process slowed by staff members’ competing priorities – A great denials management system improves efficiency and recoveries 9

To Insource or Outsource Outsourcing as a Strategy – Focus of an external team – Proven performance – 20% average reduction made possible by combining software technology with dedicated denial staff assistance – You can outsource your entire denial management process to MedPerformance 10

MedPerformance iMAD MedPerformance has a powerful and easy to use Denial Management System “iMAD” that can help you reduce your denials MedPerformance can help you with manage your denials with experienced staff 11

iMAD Contact Information For more information, please contact: MedPerformance LLC Rebecca Corzine Tarr Owner (813)