Understanding Denial Management and Its Importance
With leading hospitals and health care systems depending heavily on the revenuegenerated through insurance companies, it is to be noted that health insurersreject one out of five insurance claims in the US.
When such is the trend, the hospitals and healthcare systems must have a robustdenial management process or a vendor who efficiently supports them in ensuringan efficient denial management process.
What is a Denial Management process?
The purpose of a Denial Management Process is to investigate every unpaid claim,uncover a trend by one or several insurance carriers, and appeal the rejectionappropriately as per the appeals process in the provider contract.
In many cases, the rejection code used on a claim and the actual reason forrejection is not related. Therefore, the Denial Management Process seeks theroot cause for the denial and the coded cause.
Knowing the difference between denied and rejected claims is an integral part ofdenial management. Claim denial occurs when a claim is processed and thendisallowed by a payer. In contrast, rejection occurs when a claim is submittedto a payer with incorrect or missing data or coding.
Need for an efficient Denial Management process
An important goal for a Denial Management Process is to lessen the number ofdenials.
Denials or lower payments occur due to the following vital parameters
- Procedure
- Insurance carrier
- Provider
- Biller
If tracking uncovers a trend, providers or other appropriate personnel areinformed so that procedures can be developed to avoid future denials. To managedenials, quick follow-up is a necessity. Regularly distribute denied claims tobilling staff for management. In large practices, this should happen every day.
All correspondence is read daily for changes in billing or reimbursement policyfrom providers. This process allows providers to amend their policies andprocedures to avoid denials. Make sure to follow the insurance carrier’srequirements for appeals. Otherwise, duplicate claims can occur.
Use denial codes to educate medical billing staff when there is denial due toincorrect medical coding if you do not have the resources to handle deniedClaims Management in your medical billing department or are not achievingsatisfactory results.
Denial Management is one of the critical aspects that every practice requires toimprove its Revenue Cycle Management (RCM) and, ultimately, the quality ofservice to patients.
iMagnum – Your efficient Denial Management partner
We at iMagnum are outfitted with the best medical coding and billing experts,hand-picked for their ability in the area. These experts are constantly enrolledinconsistent staff education initiatives to have the most exceptional knowledgeof the billing and coding guidelines.
iMagnum maintains a database of such endorsed combinations by various insuranceagencies and is cutting-edge on something very similar. Our profoundly embracedcoders guarantee that the generously compensated and most elevated affirmed mixof technique and diagnosis codes are used to ensure maximum payment and instantapproval. In addition, our group of Denial Management experts works connected atthe hip with the Coding, Verification, Billing, and Posting team to investigate,resolve and carry out remedial activities across the income cycle through theprimary driver examination of any denial condition or non-payment situation.
We work with the existing data and our industry experts’ help; we providesolutions for most challenges faced by hospitals and medical facilities-relatedbusinesses. Some of those are listed below:
Our Denial Management services include:
- Identify and correct root causes of denials. All denials are routed to thedenial analysis department. Denials are segregated into line items, and fulldenials
- We work with all federal and commercial payers and have strong knowledge oftheir payment mechanisms
- Streamline workflows for greater efficiency, faster appeals, and improvedcash flow
- Our denial management and reporting app give you real-time insights.
- All claims are categorized into different follow-up groupings
- Redundant processes are automated. This cuts back on cycle times. Recovermoney faster
- Software that identifies, isolates, quantifies and categorizes denials tohelp you lower your denial rate and spot revenue leakage sources.
- Help improve revenue cycle management and financial performance
There may be varied reasons for a claim’s rejection, it may be a modifier that isout of place or a combination of codes not allowed under the CCI edits, or itjust could be that appropriate pre-authorization for the particular procedure,as mandated by the patient’s carrier was not obtained at the first instance ofthe patient coming in. For multiple challenges you face, we are the one-stopsolution provider.
