Denial Management ? Analysis vs. Calling

Posted by Ecareindia on July 29th, 2013

Medical billing companies in the US go through a lot of hardships to manage their clients’ inflated AR. It has been found in a research that the money spent in resolving the denied claims is more than the actual reimbursement that has to come in when claims get processed otherwise. This situation creates a huge revenue loss for not only the US medical billing companies, but also Healthcare Providers and Facilities. Doing a detailed analysis and making a call to the payer are two ways in which healthcare outsourcing companies learn the status of denied claims. Let’s discuss the pros and cons of these two ways,     

Calling the Payer:  Though EOBs are issued for the processed claims by payers, they fail to shed enough light on the reason for claim denials. Therefore, healthcare outsourcing companies make calls to payers to learn the status and specific reasons for denied claims. It is an easy way of knowing the claim status, however calling the payer is time-consuming, labor-intensive, and expensive. The valuable money and time invested in making calls can otherwise be devoted to performing medical billing and coding services without a hitch.    

Detailed Analysis: The other way through which healthcare outsourcing companies can learn the claim status is by doing a detailed analysis. The money involved in doing a detailed analysis is less when compared to making calls to payers. However, it may consume a lot of time in analyzing the reason for denials based on the severity of errors occurred.  Many payers also have online web-portals that give the Denial information.  Using this information, the analyst can check for repetitive pattern in Denials and if found can initiate a ‘Global’ action for all impacted claims thereby reducing the time and effort in analyzing or calling each and every claim.

Conclusion: In most cases, errors causing claim denials are easily identified through a detailed analysis. Therefore, medical billing companies need not spend a huge sum in making calls to payers unnecessarily. However, they can call the payer if the reason for claim denials is unidentified even after doing an analysis. So, healthcare outsourcing companies must use a healthy mix of both ways in order to keep their revenue cycle management healthy and unaffected. Outsourcing a part of medical billing services to reputed offshore medical billing companies like e-Care can yield more benefits in addition to the above mentioned ones.

About e-Care India:

e-Care India is one of the renowned medical billing companies in India that promises the above mentioned benefits with total customer satisfaction. With 13 years of experience in the industry, e-Care’s offshore medical billing delivery centers have been providing end-to-end medical billing services seamlessly to its clients. To know more about e-Care and its services, log on to

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