Four Strategies for Improved Denials Management

Managing claim denials is important for the ongoing success of healthcare organizations. Establishing an effective denial management process can significantly increase your revenue cycle and reduce your number of future denials. In 2012 National Health Insurer Report Card exposes that insurers deny up to 5% of claims on the first compliance. Even the best-performing medical practices have denials of 5%, according to the 2012 Performance and Practices of Effective Medical Groups report.  To avoid losing money on the table, you are required taking steps to improve your medical billing process and reduce your denials.

Follow these four strategies to denial management—identify, manage, monitor and avoid.

Retain your Denial Management Process

Losing track of denied claims is like leaving money from your back pocket. Once, it's frustrating. But as it keeps happening, you'll have a serious problem on your hands, as those denied claims have a method of piling up over time. If you don't have an organized system in place to retain track of your denials, you won't even know when they're missing in the first place.

Determine Patient Eligibility

Train your staff to gather pertinent info about every patient’s health insurance coverage and benefits eligibility. They need to remember to ask the patient about variations in insurance coverage, too. Your practice management system should have the ability to verify eligibility and advantages.

Reduce Coding Errors

Coding errors will likely lead to more denials. Take positive steps to reduce coding errors. Identify services usually provided by your practice, and then seek expert advice on how to code those services. Train your doctors how to document properly and select the correct codes. Use info technology (i.e., code correct software) to confirm the accuracy of the codes, either when the codes are selected.

Determine Medical Necessity

To avoid this frustrating condition, use software that edits charges for coverage determinations. Gather policies regarding medical need from all your insurers. Set your Electronic Health Record to alert you about services that have been deemed not medically essential or that have special requirements for establishing medical need. To appeal denials based on medical need, submit detailed documentation about the patient’s visit, as well as any current medical literature supporting the efficacy of the facility. Contact us to reduce your medical claim denials and thereby increase your income.

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