Denial Management Processes for Healthy Claims

1
Denial Management Processes for Healthy Claims
www.ecareindia.com
2
Introduction

• Revenue Cycle Management (RCM) and Denial
  Management in healthcare go hand in hand. With
  better and efficient denial management, US
  medical billing companies can achieve greater
  profits. Almost all healthcare facilities and
  billing companies use EHR (Electronic Health
  Records), today.
• It is time to update the RCM technology and
  software in order to support value-based care
  while decreasing possible revenue leaks.
• To avoid such leaks, medical billing
  companies must stop claim denials from happening.
  
• Lets follow the following best denial management
  processes to produce healthy claims.

www.ecareindia.com
3
Implement EHR

• As mentioned earlier, most medical billing
  companies and Providers have implemented EHR.
  However, there is still 31 of Providers who use
  manual claims.
• Handling manual claims is not only time-consuming
  but also slows down the denial management
  processes.
• Therefore, implementing EHR is essential for
  good denial management in healthcare.

www.ecareindia.com
4
Analyze the Common Denial Patterns

• Recognizing the common reasons for claim denials
  will help medical billing companies to stop them
  from occurring. Some major claim denial reasons
  include
• Erroneous patient demographics
• Incorrect charge entry
• Inaccurate pre-authorization
• Errors in documentation and credentialing
• Bundled or non-covered services
• Duplicate data

www.ecareindia.com
5
Implement the Denial Management Action Plan

• Once the denial patterns are identified, medical
  billing companies should work on managing them.
  They should also implement an action plan to tend
  to denied claims. The steps involved in this plan
  include,
• Directly Route Denials 
• Through this step, coding-related denied claims
  are directly routed to coders while a claim
  denied by reaching patient benefit max is sent to
  the guarantor responsibility.

www.ecareindia.com
6

• Prioritize 
• This allows, staff, to sort and work on the
  denials considering various factors such as time,
  dollar amount, and reason. The top priority
  claims are given first preference and reminders
  can be set to avoid last-minute delays.
• Standard Workflow 
• Creating a standard workflow is very important
  for better denial management in medical billing.
  To avoid duplicates, staff must take corrective
  measures by following certain protocols
  (carefully structured and designed in the
  workflow.)

www.ecareindia.com
7

• Create a Checklist 
• To avoid common mistakes, it is essential to
  create a checklist. It may include, avoid delay,
  build your case, avoid automatic re-billing,
  engage patients, request an expert and more
• Online Tools 
• with the help of these online tools, staff can
  create best-case arguments to appeal claims.
• Sometimes carrying out denial management in
• healthcare in-house could be quite intimidating.
  Therefore,
• getting help from an offshore vendor would
  relieve stress.

www.ecareindia.com
8
About e-care India

• If you are on the lookout for an experienced
  offshore denial management company, then e-care
  India will be the best bet.
• With more than 18 years of providing
  exceptional denial management services in medical
  billing, this offshore vendor will increase your
  revenue.
• ISO certified and HIPAA compliant, e-care
  provides topnotch security to its clients..

www.ecareindia.com
9
Contact US

• To know more about e-care and its services,
• Call us 1 813-666-0028
• Mail us info_at_ecareindia.com
• Visit us www.ecareindia.com

10
www.ecareindia.com