Insurance companies deny many claims submitted by providers and patients because of incorrect modifiers, wrong diagnosis codes, incomplete claim forms, and other reasons. These denials can result in healthcare practices losing a significant amount of their overall revenue, and denial management in healthcare is essential to prevent hefty losses down the line.
Implementing the best practices
Proper denial management in medical billing can ensure the practice's financial stability in the long run. By efficiently managing claim denials, a practice can increase its collections rates and revenue while boosting patient satisfaction. Healthcare practices should consider these fundamentals for effective denial management:
- Prevention –Preventive actions can minimize denials. Implement these actions during pre-admission, registration, scheduling, and billing. However, denial management experts should oversee the progress and deliver the information about the changes and the process from time to time.
- Analysis – When denials occur, analyze them to understand the cause and prevent them from reoccurring.
- Tracking Successful denial management in healthcare involves monitoring claim payment patterns and creating a system to pinpoint any deviation. It is crucial to determine the reasons for denials and enhance efficiency while reducing revenue losses.
Streamlining the process
New technologies, tools, and software solutions are available to help healthcare practices oversee denials and take immediate action when they happen. Denial management in medical billing could implement an organized system for tracking denied claims. Another option is to outsource their revenue cycle management to specialists specializing in denial management in healthcare. That way, they can get a full suite of RCM management services that can boost the health of their revenue.
More benefits to practices
Proper denial management in medical billing can also help identify business process improvements to prevent further denials. It lets healthcare practices analyze the efficacy of denial resolutions while providing timely and accurate reports to enable management to make informed decisions.