Friday, July 9, 2010

Key Functions of Denial Management

  • Maximize cash flow - Reporting identifies denial causes having the greatest financial impact, thereby accelerating cash flow.
  • Identify the root cause of denials - Collecting and interpreting denial patterns to quantify denial causes and their financial impact.
  • Support accurate workflow priorities and scheduling for follow up - Collecting information on denial appeals, including status, escalation, correspondence with payers, and the disposition of denial appeals to increase recovery amounts.
  • Provide accurate and timely statistics for Management / Clients - Providing management analysis reports and other information to prevent future denials.
  • Track, Prioritize & Appeal denials - Generating appeal letters based on federal and state statutes and case citations favoring the medical provider's appeal.
  • Avoid out-of-timely filing.
  • Analyze the effectiveness of denial resolutions.
  • Identify business process improvements to avoid future denials

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