Abstract:
Effectively managing the revenue cycle process is vital to increase healthcare organization's reimbursement levels: Yet, third- party payer denials and reductions in payments for services can impact most healthcare facilities. This systematic literature review is aimed to explore successful strategies that hospital leaders use to reduce third party payer denials and increase reimbursement rates for services provided. A search of literature transpired using three academic databases: Medline, CINAHL, and PubMed.Gov. following the preferred reporting items for systematic reviews and Meta-Analyses guidelines. Data from seven relevant articles were thematically analyzed using a screening process of constant comparing of notes, using a final consensus, and categorizing statements related directly to our research question; what successful strategies do hospital leaders use to reduce third-party payer denials and to increase reimbursement rates for services provided? The authors identified seven themes that emerged from the literature during the data analysis process. The themes included scheduling staff (57%), patient access or registration (71%), Insurance Verifiers (42%), documentation (57%), claim denials (71%), education training, policy, procedure and matrix (85%), and referral, pre-authorization or precertification (71%). The findings indicated that several successful strategies exist that hospital leaders use to reduce third-party payer denials and to increase reimbursement rates for services provided. Also, the results indicated that improvements in collection for services and reductions in denials from third-party payers commence with providing education and training to revenue cycle employees. The implications of these findings provide healthcare leaders and Revenue Cycle manager's a better opportunity to understand key factors that impact third-party payer denials and to implement strategies that improve reimbursement rates for services provided and reduce third-party payer denials.
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