Improving Denial Management Process In 2022

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Improving Denial Management Process In 2022
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Improving Denial Management Process In 2022
For any provider, theres nothing more
frustrating than a denied claim. All the hard
work is done but, through some technicality or a
minor coding error, the insurance carrier refuses
to pay. Denials negatively impact operational
cash flow, revenue, and billing efficiency. For
healthcare practices and providers of all shapes
and sizes, claim denials can be a major cost
burden. Theyre both hard to avoid and costly
when they happen, which is why its critical to
have a comprehensive plan in place to manage
them. According to the American Academy of Family
Physicians (AAFP), denials for physician
practices are between 5 and 10 percent and it
costs 25 to 30 to manage the average denial.
Improving the denial management process is the
only way to ensure consistent revenue flow and
reduce the number of denials. While getting to
zero denials is virtually impossible, reducing
them even by a fraction of a percent can have a
substantial impact on your organizations bottom
line. For improving the denial management
process, you need to understand the different
types of medical billing denials, pinpoint the
most common billing problems and take suitable
steps to avoid them. Top 5 Denial
Reasons Denials are of types hard and soft. Hard
denials cannot be reversed or corrected and
result in lost or written-off revenue. Soft
denials are temporary denials with the potential
to be paid if the provider corrects the claim or
resubmits with additional information. The top 5
medical denial reasons are as follows
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Improving Denial Management Process In 2022

• Missing information Leaving just one required
  field blank on a claim form can trigger a denial.
  Demographic and technical errors, which could be
  a missing modifier, the wrong plan code, or no
  Social Security number, prompt 61 percent of
  claim denials.
• Duplicate claim or service Duplicates, which are
  claims resubmitted for a single encounter on the
  same date by the same provider for the same
  beneficiary for the same service item, are among
  the biggest reasons, prompting up to 32 percent
  of claim denials
• Service already adjudicated This error occurs
  when benefits for a certain service are included
  in the payment/allowance for another service or
  procedure that has already been adjudicated.
• Not covered by payer Medical billing denials for
  procedures not covered under patients current
  benefit plans can be avoided by checking details
  in the insurance eligibility response or calling
  the insurer before administering services.
• Timely filing limit expired Most payers require
  medical claims to be submitted within a certain
  number of days of service. This includes the time
  it takes to rework on rejections.
• Improving Denial Management Process
• Adding more people to your denial management team
  wont necessarily help, you need medical
  specialty wise billing experts who will focus on
  the following things

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Improving Denial Management Process In 2022

• Improve patient data quality Improve patient
  data collection process done by front desk staff.
  You must have all the required patient
  information couple of days prior to the patient
  visit.
• Eligibility and benefits verification Complete
  patient eligibility and benefits verification
  process for every patient visit. You must have an
  insurance coverage report for every patient prior
  to their visit. This will ensure all provided
  insurance and patient details are accurate and
  updated. Also, request patient for secondary and
  tertiary insurance details.
• Track every claim Submitting a claim is not
  sufficient, you need to track each and every
  submitted claim. Get a payer response on them,
  whether in process, paid, rejected, or denied.
• Categorize denials Categorize denials as per the
  above-mentioned denial reason. You can also
  categorize by insurance carriers, rendering
  providers, and procedure codes. Finding a
  resolution to one such claim for a category could
  help to eliminate all rejections for that
  category.
• Form a denial management team This denial
  management team will determine what resources are
  needed to track, find resolutions, and resubmit
  claims. Provider and team members from various
  billing dept will dedicate their weekly time for
  denials resolution and its timely resubmission.
• Stay in touch with payers Your accounts
  receivable (AR) team is constantly in touch with
  payers. Before working on any denial resolution,
  discussing with the insurance rep about denial
  reason will help to understand the exact required
  information. Every payer has unique billing and
  reimbursement policies, so working closely with
  payers will ensure correct denial resolution.

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Improving Denial Management Process In 2022
Many practices lack the technology and expertise
to manage denials effectively, especially in
light of constantly changing regulations and
payer rules. Outsourcing revenue cycle management
to billing company like Medisys Data Solutions
will help to reduce denials and ensure quicker
insurance reimbursements. We can help you
establish medical billing benchmarks, reduce
backlogs, identify root causes of denials and
reduce AR days. To know more about our denial
management services, contact us at
info_at_medisysdata.com/ 302-261-9187
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