Thursday, July 8, 2010

What is denial managment soloution

 Denial :

Denial is the technical term used for the non-payment of a claim by the insurance. The insurance usually pays the claim if the details presented to them are sufficient enough for processing. If there is any lack of information then the insurance quotes a reason for which the claim is not considered for payment which is known to be the denial reason. These reasons are found in the EOB. Some insurance like Medicare follow a general set of denial codes which is uniform across all the states. But some commercial insurance follow their own set of reasons codes for the denials which will be clearly mentioned in the EOB.

For Example:-

If the claim has gone to the insurance without the patient date of birth then the insurance will not pay the claim stating a denial reason code to it.

Denial Management Solution

A good denial management process is not simply about working denials, it is about systematically gathering the data required to eliminate denials. Working denials is like pumping water from your basement when a pipe bursts. Denial management is about fixing the pipe so you no longer need to pump water from the basement.

We also understand that achieving powerful results from denial management requires data, data and more data. Our denial management process reports and measures all claims that are being denied by your payers. With this level of data our Denial Management specialists can fix the issues that are leading to the denials (whether it be issues with the claims or issues with the payers) and stop the torrent of unpaid claims into your medical billing process. Once we do this, then revenues for your practice will increase; probably by 10 to 20 percent.

Over the years we have learn that three elements are typically missing from a practice or medical Provider's denial management process: data, filtering/sorting methodologies and feedback to systematically correct errors. Most practices & practice management systems do not properly track denials - at least not in the form in which they are typically used (i.e., they may have the capability, but only if properly implemented and used). The practice management systems that do track denials typically overwhelm the practice with data that is difficult to utilize for high level denial management. Finally, even if the data is captured and can be properly utilized, most practices do not have a systematic way to get the information back into the billing process in a manner that prevents the denials from occurring again in the future.

Our Denial management Process tracks every claim that has denied and can report this by payer, by CPT, by physician and by diagnosis. This information is presented in a manner that allows fast identification of trends. With this powerful combination in hand, the Practice / Provider of medical service can then utilizes claim rules and edits that are specific enough to dramatically drive up the first pass claim acceptance and stop the flood of denied claims. Our in depth analysis described above also allows payers that are habitual violators of Clean Claim Rules to be identified and pursued. The data and analysis will allow many opportunities for process improvements and revenue enhancement for the practice.

If you implement our powerful Denial Management Solution you can optimize your medical billing and speed up your cash flow. As previously mentioned, our strong denial management solution can increase your collections by 20 percent or more.

As Denial management is a subsection to Accounts Receivables of any medical facility, we religiously follow the below methodology of managing denials from payers. Our solution is focused around the three key fundamentals to effective denial management.

  • Prevention
  • Analysis
  • Tracking and Trend Management

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