According to a handbook published by The American Medical Association called Appeal That Claim, many practices do not make any effort to make an appeal for the denied claims. The major reason behind this was physicians believe that they can’t recoup enough by appealing for justifying administrative expenses.These physicians are completely mistaken. All the healthcare organization needs to audit and appeal for their denied claims. For instance, a Chicago practice recouped $91,000 for a single procedure that was denied over a period of three years.
Get an idea to how denial management can enhance the bottom line for a medical practice.
DENIAL MANAGEMENT PROCESS
The main purpose of Denial Management Process is to look at the claims which are unpaid, uncover either by several or one insurance carrier and finally appealing for the rejected claims according to the appeal process. In majority of the cases, the actual reason and rejected code are not related. In the denial management process the actual root cause of the problem is seeked.
KEY FEATURES
Usually claim denials are caused because of late filling that indicates problems with medical billing department. There could be chances that problem lies at the registration desks, which is the starting point of revenue cycle.
- Investigate the area where lower or no pay is occurring
- Lessen the number of denial claims
- Accelerating flow of cash
- Avoid out of time fillings
- Effectiveness of denial resolution
- Scheduling with follow up and accurate workflow priorities
- Timely and accurate statistics for management
- Identifying improvements in business process for avoiding future denials
- Prioritize, track and appeal denials
If you want your revenue cycle to be optimized, you will have to improve your denial management in order to not miss a penny for your value based services.
- Don’t just submit your claim again just to see whether it gets approved in the second time. We recommend you to write a compelling letter with attaching CPT Manual, policy statement and medical literature.
- Maintain a records of all appealing letters on your shared drive. Carbon copy the appeal letter to your patients as well, asking them to contact their insurance company.
MANAGING DENIALS
- Keep an eligibility check
Patients insurance coverage at time gets changed between the scheduling call and encounter, you must verify this before the date of the service. It will help your staff to contact with the patients whose coverage does not match with the information filled in the registration form. Ask these patients about the alternative coverage. This will help you in reducing claim denials.
- Benchmark Numbers
Monitoring and measuring your revenue cycle will allow you to compare the performance of medical billing and coding done by you in relation to the standards of your industry. This will further help you in spotting the problems to improve your business. These indicators includes adjusted collection rate, aged trial balance, cash and days in receivables outstanding.
- Improved collection
You can reduce delays and costs by offering the option of paying bill online . Patients who receive collection through paper will also appreciate this convenience which will further eliminate administrative costs. Opt for predictive dialers for reducing the expense of telephoning patients. Always go for the industries that can receive and transfer the payment of patients electronically.
In today’s healthcare environment it is important to track down every source of leakage from your revenue cycle. Try to teach your staff about the most effective ways to ask for payments, citing insurance companies of the patients for payment at the time of service and to keep a follow up cycle to manage the denied claims. Definitely you don’t want to lose a single penny that you have earned. An even more effective way is to hire medical coding and billing company that can manage the complete revenue cycle while you can concentrate on the core competency.
