Claim denials and Denial Management are the most challenging area in Healthcare and Medical Billing. Every physician, medical practice, and the medical group is striving towards achieving quality Medical Billing and Coding with conscious efforts towards keeping claim denials at bay. However, billing and coding errors seem to be unavoidable owing to various reasons, making efficient Denial Management process the absolute prerequisite for every practice. Wondering how Medical Groups productively handle Denial Management and the steps involved to gain maximum benefits. Note below points explained briefly.
The first and foremost step toward Denial Management is to prevent claim denials from occurring. Right from Patient Scheduling and Registration efforts towards cleaner claims are incorporated into every scope or Revenue Cycle Management process. Quality claims are the first step toward effective denial management.
- Increased First Pass Rate: Prevention of claim denials is the best approach towards efficient Denial Management. The goal is to keep the Claim denial percentage not exceeding 5% which can be achieved only by processing cleaner claims and increasing the First pass ratio of claims.
- Audits and Analysis: Claim audits and Analysis on the denied claims can project the reason for denials. Tracking the reason and educating the coding and billing team can help reduce the repetition of claim denials for the same reason. Thereby reducing the denial percentage and increasing the first pass rate.
- Insurance Eligibility Verification: This is one prerequisite with which claim denials possibilities can be highly reduced. Every claim should be verified with Insurance for Eligibility and Benefit from Insurance to avoid unwanted slip-ups later.
With the above steps in place, Claim denials can be maintained within the acceptable percentage. With a streamlined process in place to handle the claims already denied we can ensure every dollar is collected from Insurance successfully.
Most physicians and practices focus on new claims and neglect the denials, which affects the Timely Filing Limit (TFL) and also the possibility of getting the due reimbursements. Setting up a streamlined process in place for Denial Management can help prioritize denials based on the date of Denial.
Often time the reason for neglecting claim denials is the lack of experience and knowledge to handle the claim denials and resubmit them with necessary corrections. This in fact requires the AR follow-up and Denial management team to be highly skilled and experienced in related specialties and also complete awareness of client-specific and carrier-based nuances.
Leveraging a dedicated team of Denial Management is advisable to cut down the complexities and provide skilled professionals to handle denial management efficiently and profitably. Outsourcing Denial Management has proved to be the best option and most of the practice and medical groups leverage his model for better results.
About MGSI
MGSI is a full-service Medical Billing Company based in Tampa, FL. With over 25+ years of experience in complete RCM and Medical Billing Services and working for over 800 physicians and medical groups MGSI has gained immense expertise and experience to handle every niche of claims processing. MGSI deploys a dedicated team of Denial Management experts and can guarantee timely filing and collections from Denials. To know more about MGSI and our services call 1-877-896-6474 or log on to the Website.