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Denied claims represent billions of dollars in lost revenue for the US healthcare sector. Effective denial management in medical billing and coding can plug the leaks draining your revenue flow. It's essential to work with experts who can take over the time-consuming task of resolving medical billing accounts receivable (AR) denials and deliver real results.

Plutus Health Inc. offers complete solutions for denial management in healthcare. Our team will do the below mentioned:

  • Determine the reason/s for each denied claim
  • Resolve the issue
  • Resubmit denied requests to the payer/insurance company
  • File appeals as necessary

Our custom approach to each denial case ensures effective and timely resolution. We will do what needs to be done to reverse the denial. Depending on the case, we may:

  • Correct invalid medical codes
  • Revalidate clinical information before resubmission
  • Collect relevant and/or corrected patient info and documentation
  • Send appeals letters to address incorrect names, modifiers, or invalid codes
  • Submit supporting clinical documentation
  • Obtain and complete all required forms
  • Resend appeals that don't include all documentation requirements
  • Appeal prior authorization denials
  • Obtain and document reference numbers when communicating with insurance
  • Follow-up effectively

We will also address any systemic front-end gaps in your current process to prevent denials from recurring. We can identify facility-specific or practice-specific issues within your revenue cycle management (RCM) chain that may result in denied claims. As your denial management partner in RCM, our goal is to reduce denial percentage over time and help your healthcare organization thrive.

Are you looking to outsource the management of your medical billing AR denials but have some reservations about outsourcing? Talk to us today. Plutus Health Inc. has been providing denial management solutions in healthcare for 14 years. Our team of certified medical coders can resubmit, and repair denied claims quickly and effectively following a proven process.

 

Denial management is an integral part of the medical billing RCM process. It is critical in a successful revenue cycle management as it will lead to healthy cash flow. Effective denial management in medical billing and coding can plug the leaks draining your revenue flow.

Process of Denial Management in RCM

4 Ways to Prevent Medical Billing denials:

  • Keep up with the latest knowledge on denials.

We need to keep up with the latest changes in medical billing, and it's essential to understand and reciprocate challenges and solutions. Our denial management in healthcare will help you stay in compliance with the latest regulations and rules.

  • Code all claims as per the requirements

Incorrect coding is a significant loss of potential revenue.Getting the perfect code for the claims is a complex task; we have PlutusHealth Inc. which has some rich experience with denial management in medical coding and enable good coding practice, which improves correct payment collections.

  • Do Transmissions timely and appropriately

Timely filing denials are a potential loss of revenue, and without the proof of timely filing, these denials will not be paid. Transmission of claims on a timely basis is significant in the medical billing process.

  • Lookout for Incorrect and Missing information

Scrubbing your claims before the submission is one of theproven methods to reduce the chances of denials. We at PLUTUS HEALTH have our teamwith expertise in scrubbing claims to ensure an excellent first pass ratio withour denial management in RCM.

Problems With Denials

Medical practices should aim for a 95% clean claims rate; otherwise, it is equivalent to dropping the money on the table. Maintaining a high clean claims rate increases your medical practice's efficiency and overall profitability.

If your practice continues to have claims denied, your insurance reimbursements will decline. Many practices work on small margins, and even a slight change could put your practice a risk. This is why Plutus Health Inc. provides denial management in medical coding to avoid even the slightest errors

Why Choose Us?

It's essential to work with experts who can take over the time-consuming task of resolving medical billing accounts receivable (AR) denials and delivering accurate results.

Plutus Health Inc. offers complete solutions for denial management in healthcare. Our team will do the below mentioned:

  • Determine the reasons for each denied claim
  • Resolve the issue
  • Resubmit denied requests to the payer/insurance company
  • File appeals as necessary

Partnering with PLUTUS HEALTH will bring youthe best denial management system and processes with our medical billing AR denials management. We help medical practices streamline their revenue inflow and provide access to a knowledgeable team that prevents denials from small clinic clients to large physician groups. Our denial percentage is the least in the industry.

Plutus Health's Approach for Denial Management

Our custom approach to each denial case ensures effective and timely resolution. Depending on the case, we may:

  • Correct invalid medical codes
  • Revalidate clinical information before resubmission
  • Collect relevant and corrected patient info and documentation
  • Send appeals letters to address incorrect names, modifiers, or invalid codes
  • Submit supporting clinical documentation
  • Obtain and complete all required forms
  • Resend appeals that don't include all documentation requirements
  • Appeal prior authorization denials
  • Obtain and document reference numbers when communicating with insurance
  • Follow-up effectively

What Makes Us different?

We at PLUTUS HEALTH create a team of staff that understand denials specific to your location, making identification, analysis, and prevention of denials much easier.

Daily tracking of current denials and pushing back to insurance within 48hrs makes a massive difference on the collections for those claims. We take a multi-step approach to resolving denials linked with faster claim payment and a better time to pay for the claims.

We can identify facility-specific or practice-specific issues within your revenue cycle management (RCM) chain that may result in denied claims. We will also address any systemic front-end gaps in your current process to prevent denials from recurring. As your denial management partner in RCM, our goal is to reduce denial percentage over time and help your healthcare organization thrive.

Are you looking to outsource the management of your medical billing AR denials but have some reservations about outsourcing? Plutus Health Inc. has provided denial management solutions in healthcare for 15 years. Our team of certified medical coders can resubmit, and repair denied claims quickly and effectively following a proven process.

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