How Claim Denial Management Audits Optimize your Revenue Cycle?

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How Claim Denial Management Audits Optimize your
Revenue Cycle?
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Introduction

• Most of the providers dont know about the total
  number of claims denied in the first phase.
• This is among the primary topics surveyed
  discussed, and providers are stunned by finding
  the cumulative percentage of revenue lost due to
  those initial denials.
• The need for medical documentation and the
  absence of authorizations are the most well-known
  reasons for claims denials Insurance Eligibility
  Verification services permit to check the
  coverage and benefit details there by reducing
  the denial percentage of the practice.

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• Increasing efficiency and improving billing
  collection rates should be the foremost concern
  for healthcare providers with focus on availing
  required prior authorizations and eligibility
  verification done before the service is rendered.
  
• Claim denials are the refusal of an insurance
  agency to respect a solicitation by a
  provider/person to pay for healthcare services
  got from the healthcare professionals. 
• The expenses related to not following up on the
  claim denials can affect the businesses and cause
  inefficiencies within a providers claims
  management and revenue cycle.

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• Regular denial management audit helps you to
  identify the claim denials reasons, Such as
• Duplicate claim submission
• Service previously adjudicated
• Services not covered by the payer
• Time limit for claim submission expired
• Insufficient medical necessity
• Here a few claim denial reasons are discussed in
  detail

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Insufficient Medical Necessity

• This can be a challenging situation for all
  parties, yet you might have the option to avoid
  them.
• Regardless of where medical necessity isnt
  obvious good communication among patients and
  providers is important to make the best decision
  on medical necessity. 
• At the point when a claim is denied because of
  medical necessity, your practice could be
  compelled to either assimilate the expense of
  services or endeavor to gather the whole payment
  from the patient neither of which are acceptable
  alternatives.

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Time Limit For Claim Submission Expired

• One significant issue medical billers experience
  is when claims are denied for the timely filling
  because each insurance carrier has various rules
  and regulations for claim resubmission.
• So it is a difficult task for physicians and
  billing team to keep up with the various
  timelines with each payor.
• To avoid this kind of issue outsource your
  medical billing to the best medical billing
  company that specializes in denial
  management and AR follow-ups.

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• Claims are frequently denied for timely filling
  even when the claim submitted on time however not
  got by the insurance carrier.
• There are numerous reasons this can occurs, yet
  the significant aspect of the condition is how
  the biller responds to the denials.
• Other times, claims are denied for timely filing
  when they were not submitted within the filing
  time frame because of initial errors.

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About MGSI

• MGSI is the best choice for medical billing
  outsourcing in Florida, US.
• We provide various services such as anesthesia
  billing, cardiology billing, insurance
  eligibility verification services, etc.
• MGSI enables healthcare organizations and
  enhances the revenue cycle to improve the quality
  of claims and decrease denials rate and claim
  rejection.

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Thanks!

• Any questions?You can find us at

1 [phone]
info_at_mgsionline.com
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