12 Apr ICD-10: Providers can recoup millions of dollars in lost revenue by analyzing claims denials, data scientist says
Advanced analytics and machine learning technologies are critical to pinpointing problems in large datasets that could be losing providers money. That’s why some organizations are investigating every single denied claim to better understand trends.
If claims are the lifeblood of providers’ operations, then denials are a virus that threatens their financial health. That means understanding the reason why claims get rejected, especially with the ultra-granularity of ICD-10, is paramount.
Tracy Dean, business office director for OrthoTexas Physicians and Surgeons, said that since the transition her organization does not assume any denial is a one-time, isolated event.
“We are working the claims and looking at denials ― nothing is too small not to have a conversation with the team,” Dean said.
Indeed, many providers are facing the need to adjust to correctly report the data, according to Allison Gilmore, principal data scientist for healthcare with Menlo Park, California-based Ayasdi.
Ayasdi develops advanced analytics and machine learning software for claims-denial management. Gilmore said its apps can extract denial and claim trends from extraordinarily large datasets to recoup potentially millions of dollars in lost revenue.