How to Decrease Reimbursement Denials with Better Case Manager and Provider Communication

It goes without saying that case managers are an integral part of the healthcare ecosystem. Case managers communicate about multiple patients throughout the day, often using a variety of different communication methods. With collaboration driving these mission-critical processes, solutions that ensure effective communication between case managers and healthcare providers are no longer a “nice to have,” but essential in providing optimal patient care and resource efficiency. 

Swift communication between case managers and providers is critical in reducing the fragmentation of patient care. In fact, from the perspective of case managers, gaps in interprofessional communication can hinder the optimal care of patients. Bridging the gap between providers ensures that everyone is on the same page regarding treatment plans, medications, and interventions. Effective communication also empowers timely interventions, optimizes the allocation of resources to promote cost-effective care, and creates smooth transitions of care by providing comprehensive patient information to the receiving healthcare provider, reducing the risk of errors. 

Speed Communication Between Case Managers and Providers with TigerConnect View Infographic

Barriers to effective communication 

While the importance of effective communication between case managers and healthcare providers is evident, several barriers can hinder this collaboration, including fragmented healthcare systems that struggle to share essential patient information. The impact of disconnected communication within the healthcare system can be devastating as patient care is delayed or mismanaged. In fact, communication lapses have led to a staggering $1.7 billion in malpractice expenses and contributed to nearly 2,000 avoidable fatalities.  

Unfortunately, something as seemingly innocent as phone tag can cause care delays that lead to insurance reimbursement denials. According to recent research into denial rates, out of $3 trillion in total claims submitted by healthcare organizations, $262 billion were denied. Having multiple disjointed systems, processes, and workflows within a provider organization promotes inefficiency, and it can lead to untimely filing of denials and increased costs to collect. Much of the risk of denials could be eliminated with enhanced communication workflows.

Providers and case managers are all too familiar with the frustration of trying to get ahold of each other to collaborate on aspects of the care process, including follow-up care, needs after discharge like medical equipment or sitters, clarification on orders, insurance questions, and coordinating family meetings. Timely communication will propel patient care forward, ensuring a smooth discharge process or securing insurance verifications for hospital days or treatments. 

Enhancing communication for better healthcare with TigerConnect 

The TigerConnect Clinical Collaboration Platform enables seamless communication between case managers and providers through text, voice, or video, facilitating collaboration on patient updates, insurance inquiries, and discharge requirements. TigerConnect Roles and Teams enables health systems to eliminate time wasted by manually tracking down contact information for on-call specialists or staff, allowing the right person to be found by role without needing to know their name. This effectively prevents delays in care and reduces instances of insurance denials. In addition, the platform protects patient information, improves workflows, and accelerates response times by escalating urgent messages. 

A typical hospital workflow collaboration between case managers and healthcare providers involves many steps, and it can take more than two hours for a case manager and provider to connect to discuss the patient. Meanwhile, the TigerConnect Case Manager Provider Communication Workflow accelerates the communication process between case managers and healthcare providers by more than 25%, decreasing denials related to reimbursement, reducing delays in transferring and updating patient information for their charts, and improving case manager and physician satisfaction. 

To discover further insights on enhancing inpatient care processes and expediting provider and case manager collaboration, check out the TigerConnect Case Manager & Provider Communication Workflow Comparison infographic. 

Nikki Manuel, MSN, RN-BC, Clinical Consultant

Nikki Manuel, MSN, RN-BC, is a Clinical Consultant at TigerConnect. With more than 20 years of post-acute, critical care, and nursing informatics experience, Nikki helps develop essential systems to improve clinical workflows.

Tags: Blog, case manager provider communication, provider communication, case manager, Healthcare Communication, Clinical Collaboration, Clinical Communication