If you own a small medical practice, you know that claim denials are a regular part of the revenue cycle. But what happens once those denials come?

Understanding denial management in medical billing and what you can do to prevent future denials is essential for keeping your revenue stream healthy.

The Denial Management Process – What You Need To Know

At its core, denial management involves systematically addressing claim denials. When a claim is denied, it means that the payer (such as an insurance company) has refused to pay for the services provided or the products purchased.

These denied claims can arise for a variety of reasons, including:

• Incorrect Coding
• Incorrect Patient Information
• Insufficient Documentation

The denial management process typically begins with a review of the denied claims. This review is crucial, as it can help identify the denial’s underlying cause. Suppose a mistake was made in the filing of the claim. In that case, the issue can often be quickly resolved by correcting the claim and resubmitting it for processing.

If the denial was the result of a more complex issue (such as a patient’s inability to cover the cost of a service), a more involved process would likely be required. In this case, the practice may need to work with the payer to negotiate a resolution.

Negotiations can involve the practice agreeing to accept a reduced payment for the service or the payer agreeing to cover some or all of the costs.

No matter what the underlying cause of the denial is, it is important for healthcare organizations to remain proactive throughout the denial management process. Once the cause of the denial has been determined, it should be addressed immediately to help ensure that the claim is processed as quickly as possible to prevent future claim denials.

How Denial Management In Medical Billing Can Help

Medical claim denials can lead to lost revenue and frustration from both the practice and the patient. Fortunately, having a denial management solution can significantly reduce the amount of time and effort spent dealing with denials, while increasing your profits and ensuring patient satisfaction.

Reduced Time On Denial Management Work. Automated tools can quickly perform a root cause analysis of a denial and provide actionable data that can be used to quickly resolve the issue. As a result, your healthcare organization can reduce the amount of time spent on claim denials, allowing you to redirect your staff’s efforts to higher-value cash flow activities.

Improved Patient Satisfaction. In addition to saving time, denial management systems can also drastically improve patient satisfaction. By helping to ensure that payments are received, patients can trust that their insurance companies are properly covering their care.

Moreover, these systems offer an automated way for medical practices to keep up with patient accounts and inform them of any changes in coverage.

Reduce Financial Losses From Denials. Instead of having to manually review and submit multiple appeals, or search through piles of claims to look for denial trends, a system automates much of the process and can help you quickly identify which claims need to be appealed, as well as which ones can be redirected to other payers.

Medical Billing Services & Their Contribution

If you run a small medical practice, you know that denial management in medical billing can be daunting and time-consuming. That’s why many healthcare organizations are turning to medical billing services to help streamline their denial management process.

Medical billing services such as PMN specialize in optimizing the medical claims process and helping medical practices avoid having claims denied.

By leveraging their expertise, medical practices can reduce the amount of time it takes to process claims and increase their reimbursement rate.

Firstly, dedicated denial management professionals review all claims submitted before they go out to ensure accuracy. They consult the patient’s eligibility, the codes used to describe the services performed, and other important information that needs to be included in the claim. By catching any errors before the claim is sent, medical billing services help to avoid unnecessary claim denials.

Additionally, their low denial rates and effective technology speed up the claim process. By leveraging automation, they can ensure that claims are sent accurately and quickly. This helps to reduce the time spent waiting for claims to be processed and reduces the chances of an incorrect claim denial.

Finally, PMN are adept at coding. Their denial management team is proficient in medical coding regulations and can ensure that the correct codes are used when submitting claims.

You can reach PMN at (949) 215-5055 or in person at their office in Laguna Hills, Orange County, California!

FAQs

What Should I Do If My Practice Receives A Payment Denial?

Initially, it’s crucial to conduct an audit of the claim. This includes reviewing the documentation and coding to ensure accuracy and resolving any discrepancies. If there is a problem, then the practice must appeal the denial and provide additional documentation to prove that the claims were properly coded and documented. Additionally, consider a plan for denial management in medical billing services. 

What Are Medical Billing Services?

The main goal for medical billing services is to maximize reimbursement, eliminate costly errors, and speed up the recovery process for your medical practice.

Medical billing services are responsible for making sure that medical providers are accurately paid for their services. This includes verifying insurance eligibility, submitting claims for payment, and following up on outstanding claims. The service also involves AR management, handling insurance denials, and keeping track of patient payments.