Claim management and resubmitting denied claims is a time-consuming process. It is critical to have a denial management strategy to identify, recover, and prevent denied claims quickly. The longer it takes to resubmit denied claims, the more time it will take to recover the payment from the insurer. Various denial management solutions help overcome its challenges.
The average claim denial rate is 5-10% in the healthcare industry with approximately two-thirds of denials recoverable. The good news is that nearly 90% of denials can be avoided.
Imagine being admitted to the hospital for treatment and then filing claims, hoping that everything goes well and that your hard-earned money will be reimbursed because the payer covers treatment coverage with a low rejection rate. However, the claim is denied because the patient’s information is only partially provided. Hospitals are always looking for ways to make the rebilling process easier and faster. As a result, we’ve put together a list of best practices for claims denial management solutions that will assist hospitals in handling denials professionally.
A denied or rejected claim contains one or more errors and fails to meet the set criteria, billing, and coding requirements required for claim reimbursement. Revenue cycle management companies keep denial management on top priority to streamline the process and satisfy the patients. Furthermore, they reduce the likelihood of future denials and increase practitioners’ revenues.
Healthcare companies can use several measures to avoid denials. The first step in dealing with denials is to figure out the root causes of the denials. A rejected claim is not regarded as received because it was never processed by a clearinghouse, insurance payer, or the Centers for Medicare & Medicaid Services (CMS). You can resubmit the claim after you correct the errors.
A denied claim means revenue is lost or delayed for your practice. The insurance or third-party payer received and processed the claim, but it was deemed unpayable for services received from a healthcare provider.
Payers will send you an Explanation of Benefits (EOB) or Electronic Remittance Advance (ERA) describing why your claim was denied. Before resubmitting the corrected claim, you must first determine why it was denied and correct any errors.
Denial Management Solutions
1. Claims Tracking:
It can be difficult to keep up with denied claims in real-time without quality claims tracking. Claims tracking services are critical components of any denial management process because they allow providers to track a claim throughout its entire journey. If a claim is denied, a provider and their team can address it instantly and refile it as soon as possible to ensure prompt payment.
2. Take control of your denied claims
Managing denials is a significant burden and expense for the healthcare revenue cycle. Experts are required to quickly identify and resolve denials in order to increase reimbursement, improve your appeals, and better monitor denials. To reduce denied claims, seek the assistance of a denial management solutions provider.
3. Claim Scrubbing:
Monitoring claims and highlighting common causes of denials are both important steps in your denial management strategy. Evaluating potential denials encourages more clean claims and timely payments. Denied claims are frequently the result of mistakes in medical billing codes, where a more relevant code should have been used. By stopping claims in their tracks before they are rejected, providers can quickly correct the coding issue and resubmit it.
4. Insurance Verification:
A lack of insurance coverage is the second most common reason for denied claims. A lack of coverage can occur when a patient changes insurance and misses to notify their provider, or when their coverage expires or does not reimburse for specific services. Verifying coverage for services before they are rendered is an important part of improving your denial management process. Quality denial management software now allows for automated insurance verification. To protect your physician’s time as well as your payment, your staff can proficiently confirm coverage before services are provided. Without insurance verification, providers run the risk of losing valuable revenue.
5. Data Reporting and analytics
Real-time analytics are required to avoid reporting delays. Receiving real-time data and interpreting it can aid in determining the root cause of denial. Therefore, outsource your medical billing and coding for the best denial management solutions.
Make a plan based on industry best practices.
Having denial management solutions based on best practices will ensure you get the reimbursements you deserve. As a result, you’ll have consistent cash flow, allowing you to focus on providing high-quality care to your clients.
BMB is a leading provider of denial management services in the US and a variety of other medical billing and coding services. We have a team of medical billing and coding experts who are highly skilled and experienced. We recognize the significance of lost claims and how they impact your business. Our team can assist you with automating your denial management procedures.
We help you to reduce denied claims and provide custom-tailored solutions with reporting for each client. We offer a full range of revenue cycle management services to help you boost your profits. Your claims denial rate will drop significantly if you outsource denial management to us. We employ some of the most cutting-edge denial management tools and technologies to ensure the highest quality services. Contact us to improve the efficiency of your business operations.
