Are you trying to reduce denials and improve the revenue cycle? If yes, you must take some measures to minimize denial causing factors and boost the bottom line.
The more denials, the higher the workload on healthcare providers and practices. Plus, a failure to deal with them results in revenue leakages. This highlights the need for solid denial management.
Denial management in medical billing is essential to elevating the clean claims rate. The industry reports state that an average healthcare provider gets around 18-20% denials. Denial management in healthcare is vital to reducing this number.
Whether it is recovering denied claims or solving the root cause, healthcare providers and practices require a comprehensive solution. In this blog, we will understand the concept in detail and help healthcare providers in uplifting their administrative process.
Breaking Down Denials and Denial Management
The common cause of denials is any type of error during the medical billing process. It can be at the time of recording patient information, documentation, or medical coding. Such mistakes or missing details are usually a result of manual errors or a lack of skills. Other than that, delays in claim submission can also be the cause of denials.
Denials are unavoidable, but healthcare providers must take measures to improve the situation. Thus, denial management in medical billing comes into play. It is a foolproof way to optimize the medical billing process and minimize the scope of inaccuracies. A proper system can streamline the overall workflow and help healthcare providers acquire adequate revenue.
So, what is denial management?
- Review
- Refile
- Reclaim
- Recover
The goal is clear!
However, the role of this process is not limited to just correcting errors. It also involves being proactive and making changes to avoid similar denials in the future. Taking care of denials is a challenging task. While some healthcare providers manage an in-house medical billing team, others prefer denial management services.
Let’s understand this in a little more detail and learn about the steps in this process!
Stages of Denial Management
#1 – Check all elements of denials and find out the denial sources.
#2 – Examine the reasons behind denials such as errors in documentation or coding.
#3 – Classify denials by their cause to prepare effective strategies.
#4 – Collect evidence such as documents and appeals to reclaim denied claims.
#5 – Resubmit claims and track them to ensure proper submission.
#6 – Be proactive and build a system to track and correct denial causing errors beforehand.
Since we understand the importance of denial management in healthcare, it is crucial to take corrective measures for smoother revenue cycle management.
But before that, let’s analyze the reasons behind denials in detail:
Common Reasons for Denials in Medical Billing
Let's learn how denials occur in the given parts of medical billing:
Patient Eligibility
Ensuring patient eligibility is all about cross checking if the patient has necessary insurance coverage. This may sound simple, but many denials occur due to faulty patient eligibility verification.
It is vital to know that insurance policies change with every diagnosis or treatment. Checking if the patient is eligible to receive it decides the future of a healthcare provider or practice.
Pre-Authorization
Next comes pre-authorization, which is also a major contributor to denials and revenue leakages. Meeting all authorization rules and standards is crucial to ensuring claim accuracy.
Achieving prior authorization is a time-consuming process and prone to manual errors. However, inaccuracies at this step of medical billing can be the reason behind denials.
Information Capture
Denials occur due to errors and missing details. This can happen at any step of medical billing. However, lack of precision at the time of capturing patient data, such as medical treatment, can result in errors at the time of coding.
If there are errors or missing details at the time of documentation, the chances of denials are inevitable.
Bundled Services
Coding for bundled services is quite complex. To ensure accuracy, healthcare providers must make sure that professional coders are working on it.
In case, there is a wrongful entry of different codes and modifiers, the result will be denials. So, neglecting coding is also not a good idea when it comes to avoiding denials.
Implementing Effective Denial Management
The issue and its solution – are both clear. If healthcare providers maintain proper denial management in medical billing, they can maximize revenue and elevate the workflow.
Here’s how you can decrease claim denials:
Set Up Dedicated Denial Management
If you want to streamline your medical billing, then dedicating a team towards it can be helpful. However, handling a department specifically made for denial management in medical billing is a must.
Denial management in healthcare is a task, and a single person cannot perform everything. Navigating denials and then resolving them needs a workforce. That is why healthcare providers must find a way to devote a committed team for denial management.
Find Out the Causes in Your Practice
Analyzing denials in your healthcare practices and finding the most common errors behind them is crucial. There are various reasons that can cause denials, but finding the root cause of them is essential.
Once you find out the cause, the next step is sorting them into categories. This will help in the effective recovery of revenue. Another benefit of this step is that healthcare practices can avoid the same in the future.
The team members can prepare themselves to improve the situation, upgrade the process and prevent similar errors. With this, healthcare providers can reduce the overall number of denials.
Take Prompt Action to Correct Denials
Denials do occur, but they can also be recovered by following certain steps. When a healthcare provider faces them, the step of action must always be immediate.
Prompt action can help in reclaiming denials and save revenue losses. Time is crucial in terms of refiling denied claims and ensuring revenue. Therefore, avoiding delays becomes important.
Maintain a Denial Assessment List
Another way to avoid denials is by re-checking everything, that is why keeping a checklist is vital. It is better to check everything twice than to spend time and energy on denial management.
Healthcare providers can make their assessment list and tick off everything one by one before submitting claims. If healthcare providers make this step mandatory, they can effortlessly avoid the hassle of recovering lost revenue.
Analyze the Denial Management
The task is not over with setting up a denial management team. Healthcare providers and practices must check if it is working properly or not.
Monitoring the denial management team can give valuable insights on areas of improvement.
Healthcare providers can also analyze the performance charts of the denial management team and see their progress. This way they can calculate returns in place of their investment. They can also check the impact on revenue cycle management and operational flow.
Outsource to Denial Management Services
Denial prevention is a lot more than just establishing a dedicated team for it. As a healthcare provider, you constantly have to check the claim status. For every claim denial, you will have to spend more time rectifying it. It will be time consuming and burdensome.
However, you have one more option, which is easier than maintaining your own team and following all other steps. Outsourcing denial management services from professionals.
Denial management is just a part of medical billing. So, choosing a medical billing partner is a much better option than just outsourcing denial management services.
Expert medical billing services will handle everything regarding your medical billing process. With their assistance, you will be free from any medical billing burden. As a result, you will be able to devote your time to improving the quality of patient care.
You will experience a reduction in errors, missing details, inaccurate coding and claim denials. They will ensure accuracy, efficiency and maximum revenue.
Choose Eminence RCM
Outsourcing is one of the best options to achieve an optimized healthcare practice.
Eminence RCM helps healthcare providers and practices simplify denial management. Our proficient team ensures accuracy by reducing the number of denials in the first place. Other than that, we follow well-structured denial management that recovers lost revenue.
We make sure efficiency in every medical billing step to maximize reimbursement and optimize the operational flow. Our team also ensures complete regulatory compliance to protect sensitive patient information.
Whether it is denial management in medical billing, patient registration, verification, or claim filing, our team ensures accuracy. We successfully decrease denials and optimize your medical billing process.
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