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by Plutus Health

November 2, 2021

How Denial Management Services Benefit Healthcare Practices?

by Plutus Health

Many claims submitted by providers and patients end up being denied by insurance companies 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 financial stability of practice 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 in determining the reasons for denials and enhancing efficiency while reducing revenue losses.

Streamlining the process

Denial management in medical billing could implement an organized system for tracking denied claims. New technologies, tools, and software solutions are available to help healthcare practices oversee denials and take immediate action when they happen. Another option is to outsource their revenue cycle management to specialists who specialize 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 that can 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.