Innova Solutions, Atlanta, Georgia, United States: Innova Solutions Global Healthcare Team

Written answers to the questions

Innova Solutions Global Healthcare Team, one of the nation’s leading Business Solutions companies, saw there was a need in the market for a healthcare service within Denials Remediation.

Innova leverages automation and AI that provided intelligent solutions that reduce claim denials and ensure a positive ROI. Innova help healthcare providers deploy AI at each stage of the revenue cycle that minimizes errors, provides insights into the denials, and helps avoid costly denials. By leveraging their analytics-powered end-to-end denials management platform, you can expect reduced revenue loss and improved cash management.

Denials are Insurance companies or 3^rd party payers deny reimbursement for healthcare services. The Revenue Cycle is the beating heart in any healthcare setting.

From preauthorization to precertification, underpayment collections, bill flag edits, outright denials, auditor denials, patient day denials, delays in payments, CMS updates, ICD 10 guidelines, 3^rd party payers & much more the revenue cycle system requires many moving parts;

• However, process improvements are often not prioritized due to administrative demands.
• Payment reconciliation, account appeal follow up, administration communication and lack of transparency across the spectrum are resource intensive

While denials of management investments have been focused on human capital solutions, technology development and process improvements have lagged behind. Because of this, organizations are facing a challenge to manage an increased volume of denials without the strong data analytics necessary to do so.

What is the Impact of Denials?

The impact of denials reaches an all-time high Over 11% of claims denied upon initial submission

• Denials are costing physicians and hospitals more than $1.6 billion a month
• Value of Analytics Over 85% of denials could be prevented

Healthcare organizations are struggling to keep up with new denials tactics and implement long-term change to processes within an already complex revenue record labor expenses, many struggle with the thought of adding more personnel to effectively prevent denials. Unknown financial implications have resulted in acceptance rather than process improvement and change management.  This is why Innova came up with this service to help organizations recover costs and provide solutions with their denials management services.

Innova Solutions Denials remediation management service started with healthcare providers in the first quarter of 2021.  

Timely market Issues

85% of CEO’s said the hardest part is figuring out where the problem areas are and implementing the process to correct it. Especially in departments where the staff or process workflow hasn’t been changed in a very long time.
Out of the $3 trillion in claims submitted each year, an average of $262 billion is ultimately denied by healthcare third party payers. That averages to be around $5 million in denied claims per provider. Over 200 healthcare systems were individually polled & the top 6 reasons were identified contributors to the increase in denied claims:

• 62% said their organization did not have sufficient data or analytics technology to identify submission issues
  • 61% cited a lack of automation in the claims submission & denials prevention process as the main problem
  • 46% said lack of staff training was a top challenge
  • 44% had a lack of in-house expertise in denials management
  • 33% of respondents said their organization’s technology was out-of-date and inadequate for effectively managing insurance denials
  • 30% said staffing shortages were a key factor behind healthcare claim denials.

Denials Management Solution and Service rollout

By understanding the full impact, time and costs in the industry and truly evaluating the above statistics – Innova Solutions’ denials management solution and services were being implemented by Q4 of 2021, where Innova had been selling the denials solutions and services to their clients with great success.

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Innova’s Service denials management solutions enhance their client’s revenue cycle practices, while dramatically improving the financial well-being and quality of those outcomes through collaborative, solutions-based thinking. Innova’s focus is on aligning people, processes, and technologies results in a strengthened financial and operational performance.

Innova draw on the expertise of over 100 professionals who have in-depth understanding of the claims denial management process that boost the bottom-line. By collaborating with Innova clients benefit from:

• Streamlined workflows that lead to higher efficiencies, faster appeals, and uninterrupted cashflows.
• Useful and specific recommendations for edit improvements, process improvements, and claim management.
• Services that reduce regulatory risks and improve compliance
• System-agnostic solutions that resolve the issue of underpayments.

Solutions and services features

As Innova manage claim denials, the current flow involves human intervention where data is transferred manually from Epic EHR to spreadsheets. The denials team reviews the claim and develops an action plan. Finally, if claim resubmission is necessary, the team updates the Epic records.

Some of the solution plans include:

• Know Your Stats: What is the baseline data on current denials?
• Chart Current Departmental Workflow: How do denials flow from receipt to disposition?
• Build a Denials Management Team: Who is responsible for reducing the financial impact of denials?
• Consider Payer Rankings: Are payers ranked by denial rates? Do they have customized SOPs based on their workflows?
• 5 Implement Educational Initiatives: Do you have routine education on denials prevention for each department?

Understanding & Management of Denials

• Phase 1 – Organize the data
• Phase 2 – Review denials and ascertain staffing needs
• Phase 3 – Evaluate the revenue cycle
• Phase 4 – Implement preventative measures

Benefits of Innova’s Denials Management service include:

• Recovery rate improved to approx. 98%
• Unrecovered denials drastically reduced
• Overall denial rate dropping for their clients

Innova’s denials management solutions enhance their client’s revenue cycle practices, while dramatically improving the financial wellbeing and quality of those outcomes through collaborative, solutions-based thinking. Their focus is on aligning people, processes, and technologies results in a strengthened financial and operational performance.

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Denials Management is a commitment and requires many moving parts. It requires education, application, auditing & appeal follow through. There is a SIGNIFICANT ROI in Denials Management: 90% of all denials are preventable. The Innova denials management team identify risk, appeal denials, provide education and track proficiency afterwards to ensure success will show HUGE improvements off the top. The ongoing ROI also includes increased cash flow, accurate quality scores, and reduction in administrative burden .

Market Performance

On average $262 Billion per year is lost on denied claims in hospitals across the country. This loss affects how much cash a hospital has on hand for operating cost. It costs approximately $130 per denial to rework, resubmit & recoup the payment.

This means spending money on the same accounts multiple times as well as losing money while it is held up in the denial due to the hospital not receiving the reimbursement within the expected time frame. Nationwide Hospitals spent $8.6 Billion on administrative costs alone just to rework denials over the course of a year vs Innova Solutions’ total denials in 2021 was $1.32M of that was recoverable.

Monetary results

In the denials statistic bar graph example attached, data was gathered by the Innova Solutions team as they worked on the denials for one of their clients in 2022.  

The blue bars are the dollars denied but determined to be recoverable by the Innova team.  The orange bars indicate dollars denied that were not recoverable. Specifically, for services performed in 4Q21, there was $2.66M in total denials $1.32M of that was recoverable.  In 1Q22 there was $2.38M total, but slightly over $2M was recoverable.

 As you can see, the total denial rate is dropping, possibly indicating the result of Innova’s education efforts with the client.   You can also see a dramatic reduction in unrecovered denials.   From 1.34M in 4Q21 down to $26K in 2Q22 which is a success and achievement.

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Referencing attachment labelled: Denials Management PDF.
This document was sent to Innova’s clients to help inform them of the risks and solutions Innova have to help them which contributed in the million dollar recovery deals in 2021 and 2022.

Podcast: https://www.innovasolutions.com/podcasts/
Title: what you need to know about claim denials.

Innova Speaker Event – Kelly from Innova spoke at this event about; The Strategic Understanding of Denials Management in a Tech Enable Healthcare Environment:

LHMHIMA | Fight or Flight - The Strategic Understanding of Denials Management in a Tech Enable Healthcare Environment - elearningconnex

Referencing question 5 attachment labeled: Rate of Denials Recovery Successes
In the denials statistic bar graph example attached, data was gathered by the Innova Solutions team as they worked on the denials for one of their clients in 2022.  As you can see, the total denial rate is dropping, possibly indicating the result of Innova’s education efforts with the client.   You can also see a dramatic reduction in unrecovered denials.  From 1.34M in 4Q21 down to $26K in 2Q22 which is a success and achievement.