Denial Management

With contemporary developments in the healthcare RCM, it’s imperative to reduce system’s claim denial rate. One such technique used in reducing the claim denials is denial management.

What is Denial Management?

Denial Management is the process used to review claims individually, analyze their report and question the cause of denial in detail.

Focusing on new claims without addressing the denied claims would negatively impact RCM processes.

Tips for Effective Denial Management

Claim Status – Reporting and Tracking

Following a systematic and strategic approach right from patient registration until claim closure is significant. This step-by-step formula ensures that the claims are keenly monitored through every stage and denials are filtered out through reviews, assessments and reimbursements are made available in a hassle-free manner.

Focusing on Claims Denials Processing

Engaging in newer claims or day-to-day patients’ billing processes is fine, but rejecting claim denials for that reason could produce a negative impact. Ignoring the denied claims will result in missing entry of the timely filling sheet (TFL) which in turn would create a dent in the revenue. With effective denial management in play, one can have a streamlined approach to have the perfect reimbursements with lesser time intervals and (Accounts Receivable) AR follow-ups.

AR Follow-up Support

The role of the AR follow-up team is to analyze the denied claims and would get reimbursement from the payers. Therefore, inspecting the root cause for the denials and following them up with in-house AR callers could bridge the gap, enabling successful claim rates.

Quality Billing and Coding

Medical billing and coding involve professionals who can read, interpret, track and record medical information concerning the patient’s diagnosis and treatments. Coding consists of converting the diagnosis, treatments, surgeries and medications into alphanumeric codes, enhancing the privacy and confidentiality of the medical records that protect them from data breaches or leakages.

With efficient billers and coders, denial management gets an extra hand supporting higher cash flows.

Regular Audits

Continuous auditing processes help understand the claim denial reason in detail and aids in taking appropriate steps to address the gaps. In addition, these audits enhance the denial management processes with higher reimbursements and lesser claim denials.

In summary, denial management is the need of the hour in healthcare RCM to reduce claim denial rates and enhance operations by following the tips mentioned above. In addition, it also reduces the cost by saving time and making the processes more efficient.

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