Nuances in Managing Denials with Offshore Medical Billing

Posted by Ecareindia on December 1st, 2014

On top of implementing the recently introduced medical changes into the workflow, healthcare entities have another major challenge – Denial management. The US medical claims processing companies face this challenge on behalf of their customers - Healthcare Providers and Facilities. There are certain nuances that medical billing specialists must understand before they perform medical claims processing or medical billing AR follow-up. To learn these nuances, take a look at the following two real-time scenarios that will explain how challenging it is to manage denials and the possible solutions:

Real-time Scenario 1: This scenarioshowcases the US medical billing companies that have partnered with a limited number of customers (Providers and Healthcare Facilities) outsourcing a high volume of claims.

Real-time Scenario 2: This scenario showcases the US medical claims processing companies that have partnered with multitude of customers (Providers and Healthcare Facilities) outsourcing smaller volumes of claims.

Learning the Nuances: Handling the work of scenario 1, requires a different protocol to be followed when compared to scenario 2 at denial management companies. Therefore, it is highly essential that one learns the nuances of managing denials in both these cases.

1. Global Errors: For easier denial management, one of the key things that medical billing specialists should follow is submit error-free claims so that there are no Denials in the first place! However, it does not happen in most cases. During review, if an erroneous claim is identified and the same error is on multiple claims, then that error can be globally fixed if large volumes of claims are available for a single client. Therefore, fixing global issues would be an easy task for scenario 1.

However, the same would be harder with medical claims processing in scenario 2. The reason is that they have a lot of clients with fewer volume of claims, meaning that fixing a global issue would impact only a few claims. Analyzing the errors in this case will be like ‘finding a needle in the haystack’.

2. Logs and Reports: It is a known fact that each client (Provider or Healthcare Facility) maintains dedicated logs and AR review reports. Also, there are different insurance carriers for each client. When US medical claims processing companies handle a multitude of clients with different insurance carriers like in scenario 2, then it would be time-consuming for them to maintain separate logs and AR review reports.

With scenario 1 type of denial management, this work is less time consuming but a little complicated as large numbers are involved.

3. Rules: Nuances and rules differ from one client to another. Here again, in scenario 2 where there are multitude of customers, medical billing companies face the challenge of following multiple sets of rules and processes for each of those customers.

Outsourcing a part of the medical claims processing functions to a reputed offshore medical billing company like e-care would be a prudent decision for both scenarios.

About e-care India:

E-care India has 14 years of experience in the industry. E-care’s 3 offshore medical billing delivery centers have been providing end-to-end denial management and medical billing AR follow-up services seamlessly to its clients. To know more about e-care and its services, log on to www.ecareindia.com.