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Effective Denial Management with rigorously tested strategies

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Denial of claims is a source of stress and a drain on the revenues of a practice. Therefore, denial management is a vital component of the Revenue Cycle Management and consists of four stages, namely, Identifying, Managing, Monitoring and Preventing claim denials.

Medical professionals submit millions of claims every day to payors. Most claims are reimbursed fully by payors. As per the AMA reports, claims denied on the first submission amount to 1.38% to 5.07% of the total claims. Even the best-performing practices see a denial rate of 5%. Denied claims represent delayed or lost revenue to a practice.

When claims are returned unpaid, the first step is to identify the cause of denial. Although the reason may be mentioned in code form- it may sometimes not be exact. Hence it requires time and resources to determine the cause of denial. The effort to determine the cause of denial is needed, for it is the first critical step in getting the claim paid.

Next comes managing the process of resolving the denial. It is best to follow a well thought out strategy rather than being haphazard. A well-designed workflow will be of enormous help.

Monitoring the progress of denial resolution is needed to determine where more effort is required to resolve the issues.

Lastly, all the analysis done while resolving causes of denial should result in an effective denial prevention program for the practice.

The above-stated stages in denial management will cover the following steps to be taken.

  • A well thought out workflow will track and study trends denials payor-wise. Denials are to be categorized and then determined how to resolve them quickly.
  • Billers and coders need to be trained regularly on how to handle denials. Staff education is imperative due to the constant changes in rules in the industry.
  • Internal audits of processes should be part of the workflow. Issues can be identified before claims are submitted to payors.
  • Discuss with payors how best to bring down denials and whether contracts can be amended when appeals on denials are overturned.

Bristol Healthcare Services has been serving healthcare professionals for more than 20 years. It is led by people who have decades of experience in this industry. The billers and coders are also experienced and their expertise is continually honed through staff education as the industry is seeing changes regularly.

We focus on preventive measures to eradicate claim denials. As we have long experience, there are well-structured workflows that ensure minimum denials. Bristol Healthcare Services understands the impact of denials on a practices’ financial health and so the focus is submitting clean claims to payors.

Let us help you in increasing your revenues through our superior services.