There are many reasons a health plan might deny payment for your healthcare service. Such refusal from the insurance company or carrier to honor their request to pay for your health care services is known as the Denial of claim.
Denial of claims are one of the most common barriers to effective revenue cycle management in the healthcare industry. Some sources estimate that of the $3 Trillion medical claims filled, $262 Billion were denied.
From incomplete coding and claims not being filed in time, to missing and inaccurate patient information, there are many reasons for denial of claim that are affecting the revenue cycle of healthcare businesses across the globe.
It all boils down to how efficient you are at denial management which is essential to unmask and resolve problems leading to medical claim denials. Denial management is what enables you to find the root cause of your denials and provides feedback on how to improve the claims submission process.
To assist you in enhancing your denial management approach, I have curated a set of strategies that will help you increase your revenue flow.
Track and analyze the denial claims
Keeping up with the denial claims can become a real-time hassle if you do not have an efficient tracking and analyzing system in place. Tracking and analyzing the claims can help you identify trends and implement corrective actions to prevent future denials.
For instance; without the claim tracking ability some of the denied claims can go unnoticed causing the provider to miss an opportunity to resubmit their claim.
Some of the key attributes that you should be tracking includes, Type of denial, Payer details, the reason for the denial, historical record of successful appeals processes for similar denials, and the amount of revenue lost due to the denial.
Provide accurate and complete claim information
To increase the chance of your medical claim being approved you must ensure that your medical claims forms are filled completely and accurately. Any missing or incorrect patient information can cause your claims to be denied by the insurance company
Start by checking the insurance policy of the patient and understand what is covered and what is not. Next, make sure to provide accurate details of patients’ personal information, services received, and all supporting documentation, such as lab results, radiology reports, and referral letters.
Streamline the process
Efficiently streamlining the denial process can assist you in minimizing any recurring issues while offering a long-term solution for attempting to fix the issues. Consequently, what you need is a well-organized system that can track and efficiently manage the denied claims
To create a well-organized system you must establish a team with members from different departments including billing, coding, clinical operations, and finance representatives. With an efficient system in place, you will not only have more control over your financial health but you would also be able to find more time and space to focus on your core competencies.
Automate the process
Relying on a manual denial management system puts you at the risk of claims going unnoticed as humans are bound to make mistakes. Whereas by using an automated system you would be able to identify and address denials quickly while reducing the time and resources required for manual reviews.
Let us take the example of insurance verification which is an important step for understanding the extent of patient coverage. As a healthcare provider, you must be able to verify coverage for services before rendering those services.
However, with a manual verification process, you are at risk of important revenue slipping through. Conversely, with an automated quality management system, your staff can efficiently verify coverage before rendering services and save you time and money.
Outsource your Denial Management requirements
In terms of minimizing the costs, and reducing the time and effort while still enjoying efficient claims processing, Outsourcing your denial management is always a great alternative.
With outsourcing, you also get to focus on your core competencies and avoid staff burnout, while a qualified vendor uses their experience and expertise to improve your clean claims, reduce denied claims, and positively impact your revenue.