Improving Denial Management Process Of Your Practice

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Improving Denial Management Process Of Your
Practice
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Improving Denial Management Process Of Your
Practice

• Denial Management is a key process of revenue
  cycle management. It is the process where every
  unpaid claim is investigated. It helps practices
  quickly and easily determine the causes of
  denials, know the future risks, and get paid
  faster. When practice deals with government and
  various private insurance carriers and that too
  for various billing scenarios, each denial is
  different. Key challenges faced in denial
  management are
• Increased patient responsibility Due to the
  increase in high deductible health plans (HDHP)
  patient responsibility has increased to a great
  extent and hence pressure on practices to collect
  this amount.
• Complex health plans Most private insurance
  carriers have health plans with complex billing
  requirements, so practices are facing initial
  denials.
• Value-based care Its no secret that value-based
  care affects the overall profitability of your
  practice. Certain service lines may not be
  profitable, which results in standardizing cost
  and payments though value-based care has
  positive implications.
• Outdated billing processes Many practices still
  rely on outdated paper-based billing processes or
  databases that are developed in-house. This lacks
  automation and decision support to help optimize
  denial management.

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Improving Denial Management Process Of Your
Practice

• Improving Denial Management
• Depending upon the size of the practice, you
  might be submitting thousands of claims to
  insurance carriers. Your in-house staff might be
  spending numerous hours managing and solving the
  gaps in denied claims. These denied claims
  represent lost and delayed revenue to the
  practices. Some of the strategies overcoming
  challenges of denial management are
• Firstly, start tracking every submitted claim. It
  will help you to realize not every submitted
  claim is getting paid. Bifurcate claims into
  categories like paid claims, denied claims,
  rejected claims and claims to no payment status.
  It will help you to find out denied claim
  percentage. Ideally, it must be less than 5
  percent of total submitted claims.
• Secondly, separate denied claims. You can
  separate them payer-wise, denial reason, or
  patient-wise. As you classify them, you will
  start realizing a pattern in these denied claims.
  If you see a lot of denied claims for the
  specific insurance carrier, then look for billing
  guidelines. An insurance carrier might have
  specific billing guidelines which you might have
  missed. If you rectify that mistake and correct
  it, this will apply to all denied claims for that
  insurance carrier. If there is an issue with
  insurance coverage for a patient then the
  resolution of this problem will be applicable to
  all denied claims for that patient.

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Improving Denial Management Process Of Your
Practice

• Thirdly, as you find a resolution to denial,
  correct the claim and resubmit it as early as
  possible. We will suggest that, even if you
  rectify the issue and found the resolution, you
  should talk to the insurance rep and ask for
  their assistance in this type of denial. Talking
  to the insurance rep confirms that you are on the
  right path. Never resubmit denied claims before
  talking to the insurance rep, cause, if its get
  denied again, the time required for claim payment
  will increase.
• Lastly, note down resolutions worked against
  various denial reasons. This will act as standard
  guidelines to submit claims with
  corrected/additional information to avoid denials
  from occurring.
• Practical Issues in Denial Management
• A planned and strategic approach towards denial
  management will reduce your denial rate to less
  than 10 percent. But you will require an expert
  billing team who has the required expertise as
  well as can dedicate that amount of time. Some of
  the practical issues in denial management are as
  follows
• Time consuming process Denial management and
  resolution is a time-consuming process. You have
  to track every submitted claim, sometimes you may
  not receive any response for the submitted claim
  over 30 days. In such cases, you have to call the
  insurance rep and get the payment details. Based
  upon payment details you have to classify claims
  into paid, unpaid, rejected, and denied claim
  categories. Further, you have to classify denied
  claims payer-wise, denial reason-wise, and
  patient-wise. All these things consume a lot of
  time.

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Improving Denial Management Process Of Your
Practice

• Requires expertise All denial management process
  mentioned above requires your team to have
  specific billing expertise, whether its talking
  to an insurance rep, the ability to read payment
  remarks (EOBs/ ERAs), taking payment update, or
  understanding every field of CMS-1500/ UB 04
  form. Things may get a little difficult as
  billing guidelines change as per insurance
  carrier and medical specialty. Its difficult to
  find and retain medical specialty-wise coders and
  billers.
• Its a costly process Its always advisable to
  submit a clean claim for the first time only.
  Cause if your claim gets denied, team members
  from various teams have to look into denied
  claims, find the root cause, work a resolution,
  talk to the insurance rep and do other
  activities. A study by the Medical Group
  Management Association found the cost to rework a
  denied claim is approximately 25.
• There is a simpler solution for improving the
  denial management process of your practice.
  Outsource complete medical billing operations to
  a reliable billing company Medisys Data
  Solutions. Our cost-effective billing solutions
  will help you to reduce your denial management
  challenges. To know more about our complete
  revenue cycle management solutions, contact us at
  info_at_medisysdata.com / 302-261-9187

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