Claims Denial Management: Challenges Impacting Collection

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• Claims Denial Management Challenges Impacting
  Collection

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Claims Denial Management Challenges Impacting
Collection
The denial management process is important for
successful revenue management and the purpose of
the process is to investigate every unpaid claim
as well as identify the trends of one or several
insurance providers and appeal for the denial
based on the terms mentioned in the providers
contract. Claim denials are often for most of the
healthcare organizations as they are facing
various challenges while implementing effective
claims denial management process. Providers are
engaged with several payers simultaneously which
makes them difficult to keep their claim denial
rates closer to the lower end of the industry
average. According to an American Academy of
Family Physicians (AAFP) report, the average
claim denial rate across the healthcare industry
is between 5 to 10. Claim Denial Management
Challenges Some common challenges such as keeping
track of claim denials, lack of standardization
for claim denials, manual intervention, receiving
avoidable denials, and resource-intensive process
for appealing claims are faced by healthcare
organizations while implementing effective claim
denial management systems. These challenges are
impacting revenue collection for healthcare
organizations.
Medical Billing Services in Oregon
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Claims Denial Management Challenges Impacting
Collection
Keeping Track of Claim Denials The first
challenge is keeping track of claim denials and
justifications for these denials. However, it is
very difficult for providers to gain access of
claims denial data from payers as payers are
maintaining privacy due to competitive
pressure. Lack of Standardization Second is a
lack of standardization for claim denials as each
payer sets its own rules for denying claims and
communicating denials to providers. As a result,
the healthcare industry is lacking an established
strategy for providers and payers which enables
them to analyze and present claim denials
data. Lack of Technology Usage Third, manual
intervention affects the productivity of
successfully managing claim denials as claims
denial management process is very complex and
need a large amount of data across organization
along with payers rules and code. Various
healthcare Information Technology (I.T.) tools
can easily handle such complexities to reduce the
rate of claim denials. Moreover, the automation
of claim denials management processes enables
tracking errors before submission of claims for
payment.
Medical Billing Services in Oregon
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Claims Denial Management Challenges Impacting
Collection
Incorrect or Missing Patient Information Fourth,
Most of the claims denials are the result of
incorrect or missing patient information such as
patients demographic data and other technical
errors. These errors can easily avoidable but
most medical billing and claims denial management
processes are reactive resulted in denial of
claims. The staff of the healthcare organization
needs to work proactively with the claim denials
management team to understand data required for
the elimination of demographic errors as well as
services that are covered in the patients
plan. Cost of Resources Fifth, appealing claims
through a resource-intensive process is costly
for the providers as providers spent a
significant amount of money on phone calls,
investigative work, and claims appeals associated
with reworking claims. In addition to costs,
appeal processes are time-consuming. Hence
healthcare organizations should focus on ensuring
that claims submissions are correct and clean to
avoid resource-intensive appeals
processes. Claims denial is just another part of
the healthcare revenue cycle and claims denial
management offers challenges that are impacting
the collection of providers. Medisys Data is a
leading medical billing services provider across
the USA. Reach out to our medical billing manager
to ensure correct and clean claim submissions.
Outsource your medical billing to save your time
on denied claims.
Medical Billing Services in Oregon