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Medical billing cannot succeed in the absence of strict denial management.

Medical billing cannot succeed in the absence of strict denial management.

It has been correctly stated that what you do not measure cannot be managed. This is especially true when it comes to medical billing denials. You cannot manage this critical aspect of medical billing without a strong Revenue Cycle Denial Management system in place. If you do not manage your denials, you are likely leaving more than 20% of your revenue uncollected.

Some medical billers believe denial management is the same as the follow-up, while others believe denial management is primarily concerned with medical necessity issues. Many medical billing professionals consider denial management to be a general term for the billing process.

Finding out how your billing service (or in-house billing manager) manages denials and how they measure success in this area is a good place to start in determining if your practice is suffering from poor denial management.

Fixing core denial issues and increasing collections necessitates tracking, understanding, and reporting on every claim denied by a payer. It is critical to keep track of all denials across all payers. The right denial management system provides the data needed to address the root cause of problems and significantly increase the rate of first claim submission acceptance. If your practice does not measure this level of detail, a significant amount of money is being lost in the flood of denied claims that is pouring into your practice.

A practice’s or billing company’s denial management process typically lacks three components: data, filtering/sorting methodologies, and feedback to systematically correct errors. Most practice management systems do not track denials properly, at least not in the way that they are commonly used (i.e., they may have the capability, but only if properly implemented and used). Those PMs who do track denials typically flood the practice with data that is difficult to use for high-level denial management. Finally, even if the data is captured and properly utilized, most billing groups do not have a systematic way to get the information back into the billing process in a way that prevents future denials.

Your denial management system must: 1) track all denials by the payer; 2) report on the reason for the denials and the number of claims denied for each reason; and 3) enable in-depth analysis and comparison across payers to identify important trends. Once these capabilities are in place, medical billing specialists can create targeted process changes as well as claim edits/rules to address systemic billing issues and increase collections.

Payers who are continuous violators are pursued to determine how and when they intend to process and pay outstanding claims. If the problems persist, there may be grounds to charge the Clean Claim Law’s penalties. A medical billing team can only learn how to improve the process by quantifying and analyzing the problem.

You can optimize your medical billing and accelerate your cash flow by implementing a powerful denial management system. A strong denial management system, as previously stated, can increase your collections by 20% or more.

Syanthy Healthcare services are here to help you with denial management. If you like the article, do share it, like it, and leave your feedback below in the comment section. 


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