Importance of Having the Right Denial Management Strategy

There have been changes in the payment methodology, and with the Affordable Care Act (ACA), we are witnessing a paradigm shift in the healthcare landscape. Unfortunately, despite the patient-centric care model and value-based services being at the core of this new development, the healthcare industry loses about $262 billion in claim denial out of $3 trillion. This figure translates into each provider denying $5 million on an average. The right denial management Strategy can help you to ensure no denials:

But the biggest thought is “Why are these figures important?”

When such figures are so massive in a claim denial, it won't be far-fetched to think you can get denied by the provider. Unfortunately, it means you will be losing the revenue like hundreds of other practices despite rendering the services. 

However, there are ways to combat claim denial with a proper denial management strategy. As a practice, you need to be pro-active instead of reactive when it comes to claims management.

The right strategy can help you with the following and ensure few to no denials:

1. A solution at the beginning 

Did you know? A part of the denial management system ensures that your staffs are registering the patients with the right details required for getting the 100% reimbursement. It will include the gathering of all the correct details that your practice would need to file the claim for your services.

2. Ensure meeting the deadlines

When the right denial management strategy is in place, an accurate system will automatically be developed as a part of your medical billing process that will maximize your practice workflow's efficiency. It includes keeping the entire paperwork ready and submitting the claims on time. In fact, one of the common causes that lead to claim denials is missing the claim submission deadline.

3. Understanding the claim denials

Even when you have everything right with all the correct information, there can be instances when your claims are denied. Therefore, a part of the denial management strategy wants you to understand the root causes of the denials instead of just assuming its reason. Such a denial analysis will help you further to predict any future rejections under similar circumstances and mitigate them as soon as it arises.

4. Stopping the claim pile-ups

It is quite easy to lose track of the claims denied in the manual system, letting them to pile up. In fact, it can quite be a difficult job for a practice like you to keep a track of the loss of such revenue due to claim pile-ups. All thanks to an automated claim management system software that can be put in place to keep an accurate track of the denied claims and consequently arising income. It will help you to streamline the denials and undertaking of the resubmission process to help in mitigating the revenue loss.

5. Improves the revenue collection

A proper claim denial management strategy can help in boosting the overall revenue collection of your practice. In addition, the automated streamlining medical billing and coding process will help you to improve the workflow, and the resubmission of the claims denied while keeping a track on those that your practice fails to collect timely from the insurance providers. Thus, it helps your practice to maintain the profitability level.

6. Identifying the issues

With the automation claims management system software and analytics, you can quickly check daily analysis reports. This will help your practice to identify any issue related to claims at the earliest and take care of it immediately before such claim denial related problem escalates. Moreover, it also allows you to identify the areas in your practice that can cause revenue loss.

7. Keeping up with changes

As we all know that medical billing rules and regulations are constantly changing, and you must keep up with such trends. In fact, one of the inherent reasons that lead to claim denials is the failure to stay abreast with these changes. Again, all thanks to the right denial management strategy as it can immediately notifies you about the changes happening in the medical billing and coding landscape so you can implement them. In addition, the automated claim software can be updated with such new developments to file the claims accordingly.

Final Words!

Despite the complex system of claim lodging that often leads to claim denials, it can be prevented with the right denial management strategies. Such a process starts with knowing the reasons for the claim denials, thereby training the practice staff to ensure that it does not happen again. Though you can do the entire process in-house, it doesn’t guarantee complete success keeping in mind the time, efforts, and money involved. That’s why it is usually recommended to take the help of a professional medical billing and coding company known for implementing a full-proof claim denial management system into the practice. You can consider 24/7 Medical Billing Services for helping you in putting the right claim management strategy in place for your practice.

Read more: How To Prevent Claim Denials From Payers?