Implementing an Effective Denials Management Program

Every healthcare provider in the United States deals with denied claims regularly. Although it might not be possible to eliminate rejected claims, however, providers may minimize them. 

When provider use the right approach, they can get clean claims (claims that are accepted after their first submission) up to 99 percent of the time. Providers who have a higher percentage of clean claims get paid faster and have a lower chance of not being paid at all. The five steps below will help you set up a denial management system that works for your practice.

5 Steps towards a More Effective Denial Management System:

1) Claims Management

If a claim is rejected, the medical billing company remedy the situation right away and resubmit the claim as soon as possible to ensure prompt payment. Denied claims fall through the cracks without claims monitoring feature in your denial management software, and providers may face loss of revenue.

If you don’t have good claims monitoring, it can be difficult to keep up with rejected claims in real-time. Claims monitoring software is critical to any denial management process because they enable providers to follow a claim’s progress.

2) Determine the Root Causes

Identifying the common causes of denials at your practice is an essential step in the denial management process. This is usually done by using high-quality denial management software from a reputable provider. The program will help your team by automating processes that easily identify common reasons for denials and provide solutions to prevent those denials going forward. Start looking at your top denials by payers/by reasons to determine what actually generated the problem, and most of the time it’s just a small charge entry error or a wrong payer selected during claim creation that could be fixed in no time.

3) Advanced Claim Scrubbing

Monitoring your claims and recognizing common denial triggers are both essential steps in your denial management strategy. Providers should try to prevent possible denials before they are submitted.

Recognizing possible denials results in clean claims and on-time payments. Mistakes in  coding and  are often the source of denied claims. Providers can quickly fix coding issues and try again by settling claims in the middle of the process until they are rejected.

4) Automated Insurance Verification

Lack of coverage is the second most common reason for claim denials. Verifying coverage for services before those services are rendered is an essential move towards reducing your claim denials. Automated insurance verification is now possible in almost every medical billing software. To secure both your physician’s time and your bill, your front desk staff can quickly check coverage before services are made. Providers face valuable revenue falling through the cracks if insurance verification isn’t done.

5) Hire a Medical Billing Company for Your Denial Management:

Using the services of a RCM services provider is the most important step in improving your denial management process. Providers can complete each of these phases without wasting their in-house resources by outsourcing their denial management.

Denial management software and services from a qualified billing company will help your practice boost clean claims while still concentrating on your patients and preventing staff exhaustion.

Medical billing specialists monitor and scrub your claims while delivering quality software that allows for effective and reliable insurance verification as well as the detection of common denials within your organization’s boundaries. Providers can reduce rejected claims and increase revenue by working with a vendor of denial management services and software.

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