Denial management in Medical billingPosted by Ecareindia on June 24th, 2011 It’s true that effective denial management can increase healthcare collections to a huge extent. For years and years, we know how the healthcare billing industry functions and how important it is to focus on denial management. We would be losing about 10% of collections as ‘uncollected’ amount if we don’t work on denial management effectively. That’s why denial management is given great importance, though every process is significant in medical billing. Denial management requires more of analytical and decision making skills. Whether you work for a medical billing company or a physician’s office, the gauge of your expertise lies in how you deal with the denied claims and get it paid. Even for a tough denial, there is a possibility to get it accepted by the insurance carriers through a strong re-appeal. To do that, you have to be an expert in the field, be attentive to details, and actively look for industry updates. Most importantly, you should possess logical and out of the box thinking capability.
Managing Denials: Insurance carriers deny claims if it doesn’t comply with the insurance policies put forth by them. Therefore, a farsighted approach can help a lot in handling denials and avoiding reworks. We usually learn from the denials, how not to submit a claim. But, when you have to collect others’ money, you cannot experiment. Making repetitive mistakes can be extremely costly and you have to be smart enough to avoid any such denials in the future. Let us see the four main steps to be followed to manage denials effectively:
Tips to effective denial management:
1) Maintain a separate file to enter the ‘cause for denials’ and ‘corrective measures’. When there is a peculiar case of denial, it should then be updated immediately in this file so that over a period of time, it would become a handbook for AR Analysts and would help them in managing denials more effectively 2) Provider hand book contains enormous information on insurance policies. Referring to it will solve many issues with denial management. 3) Whenever there is a new update in the industry, it should be communicated to all team members and alerts should be set in the medical billing software so that related errors will be avoided. 4) Set up a ‘utilization review team’ that will do complete denial analysis and compare denial solutions provided to different client accounts to get best solutions out of it. The team will also work on under payments and provide readymade solutions to denial issues. Give equal importance to these tips and make sure that you don’t miss out with new updates in the medical billing industry. Before you become aware that you had failed to notice the latest updates, you would be in a situation to face denials. Avoid it! When claims can be denied for various reasons, we cannot bring all denials under a common roof, but in case of global actions we need to be more proactive to act accordingly so that we can avoid similar denials. Also, whenever there are denials, it is essential to prioritize, visualize the issues and take the necessary action. Following these tips can assure you more collections than expected.
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