5 Tips for Denials Management in Medical Billing

Denials management in medical billing is one of the most crucial and tricky parts of the revenue cycle management process. It would help if you had professional guidance and the apt tools to get it right. The foremost step to correct the procedure is knowing how many denials are occurring in the organization and the different reasons for each. It is vital to have a comprehensive system to monitor the denials and their causes to get the revenue cycle management in order. Before looking for any answers to manage the denials in your organization, make sure you have a way to track them well.

Claim denials are one of the top reasons your revenue is stuck in the pipeline. Experts believe that getting a clean claim in the first submission goes a long way in ensuring that your cash flow is steady. However, it would be best if you had a competent billing team to handle the different stages of the denial-appealing process. Not all denials are the same. Hence you need enough evidence-based paperwork to help you win the appeal without complicating the situation in any way. Here are a few valuable tips to help with denials management in medical billing that you can follow.

Timely Filing Deadlines

  • In-house understaffed billing teams often find it challenging to accommodate the denial management work into their regular workflow. They are heavily burdened with the regular revenue cycle management work most of the time.
  • Denials cannot be delayed for appeals. Otherwise, they might end up not getting accepted at all. Therefore you should keep the timely filing deadline in mind at all times.
  • In many cases, the eligible clean claims end up in denials due to the delay in their submission. While you should pay keen attention to the time limit of the claim filing, you should also check whether the data is complete and correct.
  • Having an automation system where the denials are assigned to the respective teams could be highly beneficial for the organization’s efficiency. Even if you do it manually, make sure that you do not miss out on the deadline for the appeal.

Hassle-free Assignment of Jobs

  • Denials management in medical billing comes with a lot of steps. But the first point to remember is that the reasons for denials can vary between several departments.
  • Some of the most common reasons for denials are incorrect patient demographics, incomplete forms during the onboarding process, incorrect data on insurance, and, subsequently, wrong patient eligibility.
  • Denials could also occur due to errors in coding or insufficient clinical evidence accompanying the claim. Therefore various denials need help from separate departments when appealing it.
  • Establish a system in your organization where you can assign the claim rectification work to the different departments according to the reason for denial hassle-free. This will help improve the team’s efficiency while expediting the job.

Develop a Repeatable Work Model

  • Denials are a regular part of the revenue cycle management in any healthcare organization. If you want to handle the process better, you must have a working model in your structured format.
  • Automation software solutions can be beneficial in these cases. They quickly sort out the multiple denials in the organization and distribute the work according to the critical reason of the denial.
  • If you still want to take the manual route, you should keep your binders ready. But whatever be the situation, the bottom line is to have a system where you know how to handle the denials seamlessly without any chaos.
  • Accommodating denials management in medical billing procedures is the first step in this direction. You can also contact experienced professionals from revenue cycle management companies to help you develop a repeatable work model based on your unique needs.

Identify the Common Reasons

  • Reasons for denials can differ between different medical organizations. They also depend on the type of healthcare organization and the scale they function. Identify these reasons for your setup.
  • Once you identify the most common reasons for claim denials in your organization, you will get a fair idea of the repetitive mistakes occurring in your regular workflow. Make the necessary changes in your billing pattern once you know the points that need attention.
  • Data-driven reports on denials management in your organization could provide you with some meaningful insights. Once you have the statistical figures in your hand, you will be able to make a well-informed decision on which direction to move forward.
  • Research shows that few payer networks harbor more delays in reimbursement or denials than the others. It happens due to different rules associated with the claim submission process. Health data analytics will also show you which payer networks need more attention from your end.

Learn your Case

  • If you feel that your claim has been denied incorrectly or that you need further explanation to reason with the payer network, you should definitely take it up with the insurer at the earliest. But you must learn and build your case with enough paperwork to move forward.
  • You need to know the requirements or the protocol laid by the insurer to appeal against their decision. While some insurers accept a reconsideration request over the telephone, some could need a form submission.
  • Study your claim carefully to know whether you have any missed fields of information in the block. In case you find any incomplete information, make sure you complete it and rectify any mistakes before resubmitting the claim.
  • Your appeal letter will go a long way to building your case and getting your due revenue paid in time. Make sure you mention the key details of the claim and put forward the areas of contention in your letter.

We hope you will find these tips helpful to tackle denials management in medical billing. What other kinds of tips do you want to know? Let us know in the comment section below. We will get back to you. Subscribe to our blog to know more about healthcare management, current revenue cycle management issues, and healthcare technology. Follow us on Facebook, Instagram, Twitter, and LinkedIn for daily updates on the American medical industry.

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