Denial Management
Denial management is an important aspect of revenue cycle management that involves identifying and resolving issues that prevent payment for healthcare services. The goal of denial management is to reduce the number of denied claims and maximize revenue for the healthcare provider.
By addressing denied claims quickly and effectively, denial management helps to minimize the impact on the provider’s revenue and improve the overall efficiency of the revenue cycle management process. Revenue cycle management services can provide expertise and support to help healthcare providers navigate the denial management process and maximize their revenue.
What we do
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Claim denial reviewThe revenue cycle management team reviews denied claims to determine the reason for the denial and the specific details of the claim.
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Root cause analysisThe team performs a thorough analysis to identify the root cause of the denial, such as incorrect coding, missing information, or policy violations.
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Appeal preparationIf the denial is incorrect, the revenue cycle management team prepares an appeal to contest the denial and request payment for the services provided. This may include gathering additional information, correcting coding errors, or resubmitting the claim.
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Appeal submissionThe team submits the appeal to the insurance company or payer and follows up to ensure that the appeal is processed in a timely manner.
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Follow-up and resolutionThe team follows up with the insurance company or payer to monitor the status of the appeal and resolve any issues that may arise. This may involve negotiating with the insurance company or payer to reach a mutually acceptable resolution
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Trend analysisThe team analyzes denial trends and patterns to identify areas for improvement and prevent future denials.
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Process improvementThe team implements changes and improvements to the revenue cycle management process to reduce the number of denials and maximize revenue.
Features & Benefits
By reducing the number of denied claims and increasing the likelihood of successful claim submissions, denial management can increase a healthcare provider’s revenue.
By resolving denied claims in a timely manner, denial management can improve a healthcare provider’s cash flow and financial performance.
By identifying the root causes of denied claims and implementing strategies to prevent future denials, denial management can help healthcare providers better manage their finances and improve their financial performance.
By streamlining the process of resolving denied claims and reducing the time it takes to receive payment, denial management can increase the efficiency of the billing process and free up resources for other important tasks.
By reducing confusion and frustration associated with the billing process, denial management can improve the patient experience and enhance patient satisfaction with the healthcare provider.
By ensuring that denied claims are resolved in accordance with industry regulations, such as HIPAA and ICD-10, denial management can help healthcare providers stay compliant and avoid potential legal and financial consequences.