What Is Denial Management In Medical Billing?

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What Is Denial Management In Medical Billing?
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• If you own a small medical practice, you know
  that claim denials are a regular part of the
  revenue cycle. But what happens once those
  denials come?
• Understanding denial management in medical
  billing and what you can do to prevent future
  denials is essential for keeping your revenue
  stream healthy.
• The Denial Management Process What You Need To
  Know
• At its core, denial management involves
  systematically addressing claim denials. When a
  claim is denied, it means that the payer (such as
  an insurance company) has refused to pay for the
  services provided or the products purchased.
• These denied claims can arise for a variety of
  reasons, including
• Incorrect Coding
• Incorrect Patient Information
• Insufficient Documentation

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• The denial management process typically begins
  with a review of the denied claims. This review
  is crucial, as it can help identify the denials
  underlying cause. Suppose a mistake was made in
  the filing of the claim. In that case, the issue
  can often be quickly resolved by correcting the
  claim and resubmitting it for processing.
• If the denial was the result of a more complex
  issue (such as a patients inability to cover the
  cost of a service), a more involved process would
  likely be required. In this case, the practice
  may need to work with the payer to negotiate a
  resolution.
• Negotiations can involve the practice agreeing to
  accept a reduced payment for the service or the
  payer agreeing to cover some or all of the costs.
• No matter what the underlying cause of the denial
  is, it is important for healthcare organizations
  to remain proactive throughout the denial
  management process. Once the cause of the denial
  has been determined, it should be addressed
  immediately to help ensure that the claim is
  processed as quickly as possible to prevent
  future claim denials.

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How Denial Management In Medical Billing Can Help

• Medical claim denials can lead to lost revenue
  and frustration from both the practice and the
  patient. Fortunately, having a denial management
  solution can significantly reduce the amount of
  time and effort spent dealing with denials, while
  increasing your profits and ensuring patient
  satisfaction.
• Reduced Time On Denial Management Work. Automated
  tools can quickly perform a root cause analysis
  of a denial and provide actionable data that can
  be used to quickly resolve the issue. As a
  result, your healthcare organization can reduce
  the amount of time spent on claim denials,
  allowing you to redirect your staffs efforts to
  higher-value cash flow activities.

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• Improved Patient Satisfaction. In addition to
  saving time, denial management systems can also
  drastically improve patient satisfaction. By
  helping to ensure that payments are received,
  patients can trust that their insurance companies
  are properly covering their care.
• Moreover, these systems offer an automated way
  for medical practices to keep up with patient
  accounts and inform them of any changes in
  coverage.
• Reduce Financial Losses From Denials. Instead of
  having to manually review and submit multiple
  appeals, or search through piles of claims to
  look for denial trends, a system automates much
  of the process and can help you quickly identify
  which claims need to be appealed, as well as
  which ones can be redirected to other payers.

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Medical Billing Services Their Contribution

• If you run a small medical practice, you know
  that denial codes in medical billing can be
  daunting and time-consuming. Thats why many
  healthcare organizations are turning to medical
  billing services to help streamline their denial
  management process.
• Medical billing services such as PMN specialize
  in optimizing the medical claims process and
  helping medical practices avoid having claims
  denied.
• By leveraging their expertise, medical practices
  can reduce the amount of time it takes to process
  claims and increase their reimbursement rate.
• Firstly, dedicated denial management
  professionals review all claims submitted before
  they go out to ensure accuracy. They consult the
  patients eligibility, the codes used to describe
  the services performed, and other important
  information that needs to be included in the
  claim. By catching any errors before the claim is
  sent, medical billing services help to avoid
  unnecessary claim denials.

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• Additionally, their low denial rates and
  effective technology speed up the claim process.
  By leveraging automation, they can ensure that
  claims are sent accurately and quickly. This
  helps to reduce the time spent waiting for claims
  to be processed and reduces the chances of an
  incorrect claim denial.
• Finally, PMN are adept at coding. Their denial
  management team is proficient in medical coding
  regulations and can ensure that the correct codes
  are used when submitting claims.