The last decade has beholden the transformation of every practice. The change in the healthcare sector is rapid. The healthcare practices have been transformed from in-person meetings to telehealthcare management. Besides working styles, the healthcare sector has seen significant changes in the payment process. The processes and plans of Insurance companies have also been changed. Insurances companies offer programs with a low premium and high deductibles. Secondly, the complicated reimbursement processes have made it difficult for claimer to get their payment. The complex process is the main reason for claim denials. However, efficient denial management services providers assist in clearing claims efficiently.
According to a case study of denied cases, around 6% to 8% claimed patients are denied. Out of claims submitted of $3 trillion, $262 million is declined or rejected. Almost $5 million of the claim denied points per healthcare provider are incurred. Write-offs are around 3% of the total revenue.
What are Effective Denial Management Services?
Denial Management is a strategy to find out the deficiencies and problems in the claim. And after finding the problem and rectifying the reason for the denial, resubmit the claim promptly. Proper denial management services helps mitigate future claim denials or rejections.
Efficient denial management needs initial clean claim submission. A complete set of information, coding, and proper billing are required for clean claim clearance. Initially submitted clean claims are helpful in the speedy recovery of the bills.
Healthcare institutes should have a denial management team, whether it is the in-house or outsourced team. The Denial Management services provider manages proper billing and coding documentation to prevent future denials. They also analyze the payment patterns of the patient under consideration.
Types of Denials
There are two types of denial.
Hard Denial/ Rejection
Hard denial or rejection is permanent. These claims cannot be reimbursed. It is considered a loss in revenue management or accounts receivables.
Soft denial is a temporary denial. A temporarily denied case can be reimbursed after rectification and resubmission of the claim.
Reasons for Denial Cases.
The following are the main reasons for denials.
A claim can lead to temporary denial if some information of the healthcare provider or patients is missing or wrongly entered.
If the claim is duplicated, it will be denied or rejected. The reason for duplication can be human error or system error.
Previously Settled Service
A claim is denied if the reimbursement of the claimed service is already settled. Claims are denied when the details of the patient about insurance are incomplete.
Not all healthcare services are covered in an insurance plan. Different insurance companies provide insurance claims with varying services of healthcare covered in it. If a claim is made against the intangible or service or the service not covered in the specific insurance plan, it will lead this claim to rejection.
Overlooked Time Limit
The claims can be reimbursed if they are submitted or resubmitted on time. If the time limit is overlooked and claims are presented to the insurance company. It will lead to denial.
Strategies for Effective Claims Denial Management
Patient Information Eminence
Collect the Patient information like name, National Identity card number, demographic location, insurance information, etc., at the time of registration. This data should be saved through automated systems. To attain vast quantities of data, you should switch to cloud-based EHR systems.
The overlooked deadlines are one of the reasons for denials. An AI-Enabled system can optimize the claim management process.
Track the reason for Claim Denial
A continuous internal audit is required to avoid the reasons for denials. An audit before submitting claims will help you submit clean claims. A secondary audit after the veto is mandatory for tracking the reason for rejection.
Manage the Denied Claim Cases
After identification of the problem, the next step is to rectify it. After fixing the problem, the denial management services provider prioritize the denied claim. Firstly, resolving the denied claims is our priority. In this way, the process and the workflow of denied cases are standardized.
Appeal the Cases with Documentation
When a claim case is denied, we audit the complete subject and identify the reason for denial. If this reason is correctable, we file an appeal and resubmit the claim again for reimbursement. The process requires prompt action. Our experienced teams reimburse them using their efficient skills. Take account of patient records in support of an appeal. The credentials of patients and health care providers are an essential aspect of a claim. A healthcare professional can request a deadline of payment that can communicate to the insurance company.
Evaluate Denial cases with Automated Claims Management System Software.
Invest in technology that automates the process of claim management or outsourcing the process will streamline your revenue management cycle.
Automated workflow leads to efficient claims management. Our proper analysis of denied claims and prompt resubmission reduce the chances of denials.
Follow up the Advancement:
To keep our revenue cycle running smoothly, we follow up the process from the start to the end. The process is essential to follow up with patients to get missing information and to claims clearinghouses and insurance companies for speed.
Notice the trend of denials while dealing with insurance companies. Usually, the denied cases have common reasons for rejections. Medical Billing companies identify the common causes and try to minimize these reasons in the future. We also investigate the uncommon or unique explanations for the denial and solve them promptly.
Creating a well-trained task force responsible for claim management is the first step towards better and profitable revenue cycle management. Ensure the team communicates well with the insurance, clearinghouses, and patients. Managing an in-house team costs a lot of money, and maintaining this team is continuous.
On the other hand, it takes a lot of time to train the staff. Outsourcing a medical billing company helps you save the cost of staffing, managing systems, and software. It is also time-saving. The outsourced billing companies are equipped with trained billing and coding staff, and they keep their team trained and up to date.
BellMedex denial management services keeps your claims continue to reimburse and reduces claim denials