Denial Management In Medical Billing. Claim rejections have a severe impact on the cash flow of any medical practice. Claims that don’t meet the set criteria of the insurance companies or carriers stand to be rejected and hence the provider loses money. A high percentage of clean claims (claims that are processed without errors) can only be realized with flawless denial management in medical billing and that demands domain expertise. To avoid serious repercussions of claim denials on revenue generation, practices should adhere to the following tips that would help them with an effective denial management strategy.
Zero in on the cause
For any insurance claim denial, there must be an underlying cause which the care provider should identify. Some of the common causes of denials include the ignorance of the patient about the insurance policy, flawed claims documentation, and a regulation that the medical staff is unaware of, among many others. Once the cause of denial is known, the denial management process can be fine-tuned to address that loophole and keep it from resurfacing in the future.
Accurate information processing
The process of gathering the necessary claim information starts from the front desk. For this, the billing department and the front desk staff should work in sync to get the correct and updated information about the patient and their coverage. While doing the paperwork, the individuals involved must maintain the utmost caution to ensure zero information error. They must double-check the details being entered in the documents before they are sent to the insurer.
Owing to the sheer workload, it’s not uncommon for practices to lose track of the denials and this can lead to piling up of denied claims. Since the employees are already overstretched, the management can’t expect them to keep track of all the denials, which would ultimately lead to revenue loss. An effective solution is the automation of the claims management process with the help of a seasoned vendor. Automation would handle repetitive tasks and streamline the entire process for better outcomes. The staff would be better equipped to track the claim cycle and intervene with timely actions to get their claims approved.
Claims that aren’t submitted within the stipulated time are denied. But sticking to the stringent timelines of insurance companies and carriers is way more difficult than it sounds. This can be attributed to the countless large, tiny, and resource-hungry processes that form the claim submission. Hence, there should be a proven workflow in the place with preset protocols to follow. The staff must be adequately trained to handle anomalies in the denial management in the medical billing process and ensure the timely submission of claims.
Once a claim is submitted, the management should be proactive in tracking its progress and make sure that there’s isn’t any roadblock to its approval. Close monitoring of the approval process would also help them identify areas of improvement to improve the claim approval rate. For requests needing resubmission, there must be processes for the analysis, correction, reevaluation, and resubmission of the claims within the stipulated time.
By employing the right people and deploying the best technologies for denial management in medical billing, practices can realize minimum claim denials and boost their collections. A proven way of doing this is the outsourcing of the denial management services to a trusted insurance services vendor that can ensure the maximum claim approvals for their client.