BI Tools - Denial Analysis

Using the Denial Analysis Tool

This tool helps you to identify the denial trend for your practice to work on those denials and also to set a workflow to avoid the denial in the future. In the Summary  you can find the top 5 denial reason, the top 5 codes which were getting denied and the top 5 insurances denied the claims based on the denial amount.

Denial Analysis Explanation

  • Filters Explanation (Only shows denials)
    • Posted/Check/Appointment Date:
      • Posted Date: Date the claim is billed to insurance and begins showing up in the drchrono system.
      • Check Date: The date that the check was received.
      • Appointment date = the date the appointment occurred on.
    • Date Range: The first date box is the start date of the range you would like to view. The latter date box is the end of the date range you would like to view. This box calculates from 12:00 AM on the start date to 11:59 PM of the end date.
    • Patient: Narrows your search to a specific patient. If no patient is entered, this search applies to all patients.
    • Offices: Narrows your search to a specific office. If no office is selected, this search applies to all offices.
    • Rooms: Narrows your search to a specific room within an office. If no room is selected, this search applies to all rooms in the selected office. This option is only available if an office is selected.
    • Display unbilled transactions only: Choose to displayed transactions that have been set as 'Bill to Insurance'.
    • Display claims with zero balance: Displays claims that have been autofilled with patient payments.

Calculations

  • Summary Page
    • The blue bar displays the dollar amount sum of denials for the top five CPT codes within the date type, date range and patient specified.
    • The red bar displays the dollar amount sum of denials for the top five Claim Adjustment Reason Code (CARC) within the date type, date range and patient specified.
    • The green bar displays the dollar amount sum of denials for the top five Payer ID Codes within the date type, date range and patient specified.
  • Detail Page
    • Each row in the Details table represents a different reason code/CPT code/payer
    • In each column, the number produced is the dollar value sum of denied claims that are 0-30, 31-60, 61-90, 91-120, and 121+ days old. This number is calculated from the date type (Posted Date, Check Date, Appointment Date) and date range you selected.
  • Denial History Page
    • Total Denials
      • The bar graph pulls information based on your choice of date type: Posted Date, Check Date, and Appointment Date. The graph is then created from the dates of your denials, calculating the month-by-month sum.
      • Each bar is the dollar value sum of denials that fall within that particular month.
      • The percentage is the percentage change from the previous month, calculated with the formula: Current Month Total / Preceding Month Total - 1. 
    • Denial Percentage
      • The line graph pulls information based on your choice of date type: Posted Date, Check Date, and Appointment Date. The graph is then created from the dates of your denials, calculating the month-by-month percentages relative to your total collections.

In the Detail tab, our system will show a break down by denial reason for the denials you have received for a specific date range, you also have an option to further break down the report by CPT & Insurance. With the help of this tool, you can easily identify which insurances denying what specific CPT codes for what reason.

 

If you want to see only the denials which are not corrected/worked, you can check "Display unbilled transaction only" checkbox and if you want to ignore the denials for the claims which we were already zeroed out, then you can uncheck "Display claims with zero balance".

In the Denial History tab, our system will show a comparison based on the denial amount for the last 12 months to understand the practice's progress on the denial management.

 

 

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