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Denial Management: Strategies to Prevent Claim Denials

What is Denial Management?

On an average, around 20% of the entire revenue of healthcare providers falls prey to denials. 1 in every 5 claims is subjected to denial and there are no cheerful stats for any healthcare organization. Healthcare service providers face a setback when a rejected claim goes unattended & is never submitted. This is where the need for Denial management arises, the Denial Management process detects & resolves the probable problem which could have lead to denials, thus shortening the accounts receivables cycle & prevents the revenue from being spent unnecessarily. Denial Management is a critical process that every revenue cycle management healthcare organization must make provision for.

Impact of Denial Management On Healthcare Providers

Financial stability is the aspect for most of the healthcare organizations to achieve to attain functional efficiency. Claim denials do not cause any harm unless the occurrence is frequent. Most of the organizations face many challenges in implementing an effective policy regarding claims management.

Most of the denials are preventable but still occur. Receiving a denial is a challenge in itself as there are several obstacles in adopting an efficient denials management system. Some of the problems like missing information about the patient, duplicate claim submission, services not covered by payer or time limit for claim already passed are the root cause for most of the denials.

To prevent it an organization needs to be proactive to ensure the data collected from the patient while they are admitted is accurately collected and reported at the point of service. From the viewpoint of rcm solutions getting the most informative details stars right from patient scheduling and patient registration. It provides the groundwork for the claims to be billed and collected in the best possible manner. Front-desk staff needs to work with the medical billing team to understand what patient and insurance data are needed to minimize demographic errors.

The healthcare organizations should also implement a zero-tolerance policy for late submissions of claims. Appealing denials without any doubt imparts extra burden on providers in terms of money & time, but they should not in any scenario give up reimbursement.

How To Master The Art Of Denial Management?

Make sure your organization is equipped with a highly observant team of management professionals that are determined to minimize the lost reimbursements. A large proportion of rejected claim goes unattended and are never resubmitted. Design your receivables methodology in such a way that the main focus is on shortening the account receivables cycle.

Try and provide tailor-made solutions to the customers based on the client’s needs. It may include the processes of the likes of preparation of the appeal letter along with the required documents to be reprocessed by the payers. The Denial Management team should focus on establishing a trend with the help of analytics to make sure the acceptance of a claim. Getting handy with the usage of data analytics will take the organization a long way as previous client data speaks volumes about the patient and narrows the further procedures substantially.

The invalid medical codes that are in place are needed to be corrected and submitted along with other documents along with the establishment of a transparent appeal policy.