How to Optimize Your Denial Management Process

How to Optimize Your Denial Management Process

How is your denial management process? If it’s not optimized, it will affect your revenue cycle. Learn how to optimize it here.

Doctor’s offices need to go through a lot of red tape when dealing with insurance companies. They could complete a procedure, but the insurance company denies the claim based on a technicality or seemingly for any reason.

It’s important to minimize your denials and submit clean easily processed claims. Denial management is essential for healthcare companies. Every denial means longer to wait for money.

It means additional costs for cleaning and resubmitting the claims.

We’ll examine ways you can help streamline the process to reduce the denials and make denial management in healthcare more efficient.

The Cost of Denial Management

1 Us Dollar Bill

Without a denial management system, your technicians must sift through endless codes to find the correct ones. If they make a single mistake, then the insurance company uses that to deny the claim.

While we know they should approve the work, insurance companies look for any reason possible to deny a claim. Once they deny the claim, the technicians must once again go through the claim, find what’s wrong, and fix it.

This costs the time of the technician and because of that, you make less money. Therefore, it’s important to not only have efficient denial management but also clean first pass claims.

The Fate of Denied Claims

Insurance companies know doctor’s offices and hospital billing departments are busy. They don’t have the time to process claims and then reprocess denials.

This decreases revenue because many people don’t process denied claims. Instead, they get passed on to the patient. This forces them to deal with the insurance company.

This loss of revenue caused several healthcare agencies to begin a prevention-focused claim denial strategy. Denial management in the healthcare process includes developing automated processes and analyzing denial reasons. By examining these issues, you improve your revenue stream.

Analyzing Claim Denial Reasons

Woman Coding on Computer

One of the biggest assets in denial management in medical billing ls is understanding why they happen. The most common causes of claim denials include missing information, incorrect patient demographic, and technical errors.

You can avoid 90 percent of claim denials. Human error is inevitable, but the bulk of these issues can be avoided.

It requires better examination by the technicians. Programming that provides automatic filling of information also helps.

Duplicate claim submission is another common issue. Insurance companies deny the claims and send duplicates back. One of the best ways to stop submitting duplicates is the use of programming to keep track of claims.

Many times, the insurance company decides it doesn’t cover the services offered by the hospital or doctor’s office. There isn’t much to do for services not covered by the insurance company.

Insurance claims have an expiration date. If the billing department doesn’t get the claims out promptly, then the insurance company denies the claim. There are programs that make sure you don’t forget about insurance claims.

A key to decreasing this is have the claims correct before sending them. Traditional denial management is reactive. They wait until they get the denial from the insurance carrier before examining the claim.

Checks and balances can keep these common issues from happening if technicians examine the claims before being sent. They track the claim denial rate and set goals to decrease it.

Get Accurate Information from the Beginning

Insurance companies deny many claims because of missing or incorrect patient information. This is part of the front end revenue cycle management and your denial and appeal management. Nurses and health providers should get the information ahead of time and input them into the billing system.

The billing department doesn’t access the patients. They don’t see the patients to get the information, so it is up to the main office staff.

If the insurance company denies the claim because the service isn’t covered, hospital staff can check to see if they cover the procedures ahead of time before doing them. By the time billing gets the claim, they did the procedure. They have no way of knowing that it isn’t covered until they get the denial.

Families dealing with medical issues already have a lot on their plate. They’re dealing not only with the medical issues but the stress of the bills and hardships of life. The last thing they want to deal with is a denied claim.

By making sure the claim is correct and covered ahead of submission, it’s good not only for the healthcare provider but also the family. Imagine how the family would feel if they received multiple treatments not covered by the insurance and not aware until weeks after the procedures.

Automation Can Make Claim Denials More Efficient

Person Holding Blue and Clear Ballpoint Pen

Relying on people can help improve denial management services, but people are fallible. No matter how well they try, there are always going to claim that slip through the cracks. This is where automation can help.

Many healthcare providers still use manual claim denial management, but automation can help process payer rules and codes faster and more efficiently. There are thousands of diagnostic codes and varying insurance policies to wade through.

Automation reduces research time and lets the billing team check the claims before they are submitted. Automation also utilizes analytics so you can optimize the various denial management strategies. Analytics also includes interactive reports and other data that can help set benchmarks for claim denials and improve overall strategies.

Hospitals and healthcare agencies can also outsource their denial and claim management systems.

Don’t Let Claim Denials Run Your Revenue Stream

Hospitals and healthcare practitioners suffer revenue loss from claim denials for many reasons. Denial management systems can help recoup the losses and allow for more efficient proofing and data collection for claims before submitted.

If you want to learn more about claim denial management, then please feel free to explore our site and contact us.