By Lee 
No healthcare provider ever wants to be unhealthy. But rejected claims can make it more difficult for money to flow and hamper revenue. A claim denial is when an insurance company will not pay for a medical service. There are many causes for these denials, including missing patient information, coding errors, late submission or services not covered under the patient’s insurance plan.
When denied claims are not dealt with correctly your practice is losing money and spending extra time doing paperwork. This is why expert denial management services are critical. They help healthcare providers resolve claim issues, recapture lost revenue and maintain operations.
Denial management is the practice of dealing with denied claims. It ensures that your practice is getting the money it deserves. Here are the main benefits:
- Recoup Lost Revenue: A denial is a delayed payment. By working denials, you can receive money that would have been lost.
- Enrich Cash Flow: Faster settlement of claims leads to more cash flows and frees you from financial worries.
- Less Administrative Burden: Let the payment experts deal with paperwork, follow-ups and appeals, so you can focus on patients.
- Analyze to Ensure Compliance: They avoid repeated denials by making sure claims comply with insurance regulations.
Experienced denial management professionals do not just figure out what they should do about a denied claim, there is an established approach to doing it right.
Claims from submission to payment are all supervised by professionals. They see denied claims quickly so that you can respond.
Every rejected claim is reviewed to determine the specific cause. This may be for any number of reasons such as a coding error or lack of documentation or coverage.
Once the mistake is spotted, the team corrects it and refiles the claim. Resubmission on the basis of appropriate and constructive review can improve potential for resubmission.
Some denials need appeals. The appeal is prepared by the team and correspondence made until settlement.
Experts in denial management provide reports that identify trends in denials. These are learning points that help the practice optimize process and avoid mistakes in future.
It save time, produce revenue, and that is the reason why most practices now even employ specialized denial management services. Here are the key benefits:
- Expert Knowledge: Experts understand insurance regulations and claim processes. They are swift and efficient with denials.
- Quicker Recovery: Outsourced teams only work on denied claims, resulting in a quicker recovery rate.
- Save Money: There is no need for additional staff or training. Experts handle the process efficiently.
- Shift focus to patients: Your team can devote more of their time to patient care, and less time chasing payments.
Determining why a claim is denied prevents future losses. Some common causes include:
- Errors in patient information
- Mistakes in medical coding
- Lack of required documentation
- Services not covered by insurance
- Late submission of claims
Understanding these causes helps denial management teams not only resolve existing problems, but also prevent new denials.
And those that leverage expert denial management see quantifiable results. Denial rates fall, revenue recovery increases and the staff functions more efficiently. It financially strengthens the practice over time and lets doctors do what they know best – taking care of patients, not paperwork.
The one that got away doesn’t have to stay lost. Expert denial management to help health care providers recover revenue, accelerate processes and remain financially viable. These services review, correct and resubmit claim denials to payers in pursuit of Medicare payments on a very high percentage of previously denied claims.
It makes good sense to invest in denial management software. It’s a time saver, stress reducer and revenue enhancer for your practice. And it enables healthcare providers to do what’s most important, which is to take care of patients.