Results-Driven Denial Management Solutions
< 30
Days in AR
10-15%
Revenue Increase
97%
First Pass Ratio
96%
Collection Ratios
98%
Clean Claims Rate
Denial Management Services in Healthcare
In the USA, hospitals spend nearly $20 billion on denial management each year. Claim denials and the failure to collect reimbursements for the procedures and services performed adversely affect the financial health of medical providers and lead to reduced staff morale. Relying on in-house denial management solutions adds to the overhead costs, increases the administrative burden, and delays payment collections.
On average, hospitals around the country write off $5 million annually due to unresolved claim denials. Often, healthcare providers don’t have the necessary resources and time to correct and resubmit claims or file appeals. However, they can outsource denial management services to professionals and get personalized solutions at every step of the resolution process.
Denial Analysis and Reporting
The team carefully studies every denial code to identify the reasons. A detailed list is prepared, and trends/patterns are examined to recognize the recurring reasons for denials and resolve them. The report is shared with the healthcare provider.
A/R Recovery Services
The A/R recovery process investigates denied claims and follows up on resubmissions to ensure maximum reimbursement rates. From identifying unpaid claims to negotiating payment disagreements, the A/R recovery service includes all steps.
Payer Compliance in Claim Denials
Non-compliance with medical billing regulations is another reason for claim denials. Experts ensure that proper coding procedures are followed and claims are resubmitted in compliance with payers’ contractual obligations for denial reversals.
Claims Rework and Resubmission
The process of claims correction is intricate and requires denial management service providers to backtrack, verify, fix errors, and provide missing information, while resubmission includes creating a new claim to replace the denied one.
Appeals Management Services
If the claims were denied unjustly, appeals could be filed to reverse the decision and collect the rightful reimbursements. The denial management team gathers the necessary documentation (EOB, pre-authorization letters, original bills, etc.) to submit an appeal.
Policy & Procedure Development
Internal audits are conducted to pinpoint the root causes of denials. Strategies are devised, and best practices are adopted to improve the first-pass clean claims rate and prevent denials in the future.
Outsource Denial Management Services To MediBill MD
Not just qualified but certified! Our team is comprised of board-certified denial resolution and management specialists who leverage their knowledge and skills to identify, reverse, and prevent claim denials.
Get approved in the first go! We have a track record of 95% first-pass clean claims rate. So, we know how to rework denied claims and get them approved for full and faster reimbursements.
Building a culture of compliance! Our claims denial resolution and management process includes compliance at every step. We diligently adhere to ethical codes of conduct, industry guidelines, and regulations.
Saving you from the cash flow woes! Our effective denial management services increase your net collection ratio by 96%, adding significant revenue to your practice. With a steady cash flow, you can focus on success.
Healthy practices make happy patients! At MediBill MD, we fight denials and take care of your healthcare practice’s financial health so you can provide quality care for improved patient satisfaction.
We Are Available Nationwide
Get customized denial management services throughout the country. We may be based in Dallas, Texas, but our unique denial management solutions are available across 45+ specialties in all 50 states of the USA.
Simply select your location on our interactive map or advanced search tool, enter your details to book a free consultation, and unlock hassle-free claim denial resolution in one click.
MediBill MD Solutions for Common Causes of Claim Denials
Did you know that minor errors like leaving a ‘required field’ blank or stating the wrong Social Security number or plan code can prompt 61% of denials? And that’s not all. These oversights result in 42% of all the denial write-offs.
The common causes of claim denials range from incorrect coding to the provision of non-covered services. MediBill MD’s tried and tested denial management services systematically address each reason to counter and prevent denials, in turn optimizing the practice’s cash flow.
| Common Causes of Denials | MediBill MD Solution | |
|---|---|---|
| Incorrect use of codes and modifiers | Certified professional coders (CPCs) are equipped with the necessary knowledge and skills to accurately code patient encounters, medical procedures, and services as per the latest coding guidelines. | |
| Missing information | The team rechecks superbills and claims to ascertain that all the provided information is correct and complete before the final submission. | |
| Duplicate claims submission | New claims are cross-checked against all the previously submitted claims (maintained on a Cloud database) to avoid duplications. | |
| Lack of medical necessity | Medical billers and coders recode the procedures and provide the essential documents to meet the payers’ medical necessity requirements. | |
| Patient eligibility issues | Before submitting claims, the MediBill MD team verifies patients’ eligibility for insurance benefits to determine terms like coverage, copay, deductibles, etc. | |
| Insufficient documentation | MediBill MD’s coders and billers are well aware of the documents required by the payers for claims processing and timely communicate with the healthcare providers if the paperwork is incomplete. | |
| Late claims submission | MediBill MD prides itself on quick turnarounds. Its team of experts works 24/7 to collect and process the information for timely claims submission. | |
| Non-covered services | EOB is thoroughly read to confirm if the rendered services were uncovered by the plan. In case of discrepancies, the claims are reworked with accurate codes and modifiers. | |
Our representatives are available around the clock to offer prompt assistance and answer your queries. Contact us on our dedicated helpline number or the live chat to request the information you need immediately!
Our Denial Management Process & Workflow
Denial management is an important part of revenue cycle management. Without it, practices can lose money on every 1 out of 5 claims submissions.
MediBill MD’s well-curated denial management process includes step-by-step resolution, offering complete transparency at every stage. From recognizing to preventing denials, these 6 effective milestones are the foundation of our workflow.
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1. Identifying the Cause Analysis
The first step in the denial management process is to read the denial letter (with the denial code stated on it) and understand what led to the payer denying reimbursement for the claim.
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2. Verifying, Cross-Checking, and Examining
If the denial was the result of incorrect or missing information, then the patient details are verified, cross-checked, and rectified for clean claims submission. Available documents are examined for discrepancies.
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3. Gathering Supporting Documents
If the claim was denied due to insufficient documentation, then our experts request the required documents from the provider and attach them with the new or reworked claim for resubmission.
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4. Appealing the Denial
Denials can be appealed if the decision is unjust and the providers hold the right to accurate reimbursements. Evidence is collected (e.g., EOB and medical necessity letter) to file an appeal and reverse the decision.
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5. Tracking the Results
After the claims are resubmitted and appeals are filed, the team tracks the progress and follows up with the payers. Some payers can approve the reworked claims in 48 hours, while others may take longer.
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6. Devising Prevention Strategies
The last step of our denial management process includes extensive audits and strategy formulations to prevent denials. From training the staff to automating processes, steps are taken to reduce the denial rate.
At MediBill MD, we offer comprehensive denial management services at unbeatable prices. With our all-inclusive solutions, you can crush denials without breaking the bank and improve your cash flow today.
Price Comparison Calculator
Based on your annual collections, we will calculate the in-house medical billing cost and compare it with the MediBill MD service charges.
Our results speak for ourselves! MediBill MD is a well-trusted name in the industry. Our healthcare billing specialists optimize the revenue cycle of over 300 verified practices.
Significance of Denial Management Service in RCM
Claim denials make up 90% of missed revenue opportunities. Around 1 in 5 healthcare providers in the USA are losing $500K in revenue each year due to denials. Therefore, in the healthcare revenue cycle management (RCM) process, claim denials pose the greatest threat, leading to significant financial challenges.
Employing effective denial management services can recover aging accounts receivables, improve providers' net collection ratios, ensure a steady cash flow, and enhance patient satisfaction. Proactive denial management and resolution strategies optimize healthcare organization’s revenue cycle, resulting in growth and success.
Trusted RCM partners like MediBill MD leverage specialty-specific expertise, the latest technology, industry knowledge, and compliance-based billing to turn denials into dollars for their clients’ enhanced financial performance.
Get in touch with Denial Management Specialist
Let a denial management specialist fight your case! Our certified denial managers use proven strategies to overturn your denials and plug revenue leakage at its roots. Get in touch today!
FAQs
Denial management is a sub-process of revenue cycle management (RCM) and entails identifying, investigating, analyzing, resolving, and preventing claim denials. Since denials represent 90% of missed revenue opportunities, RCM experts prioritize denial management to maximize a healthcare provider’s cash flow.
Denial management and A/R Follow-up teams collaborate to identify and review unpaid claims. The A/R team tracks the progress of a submitted claim to monitor its recovery days. Reports and notifications about aging A/Rs are sent to the denial management specialists for rectification, resubmission, and appeals. Their collective goal is to recover lingering revenue and optimize cash flow for the practice.
Denial codes are standardized alphanumeric identifiers used by healthcare insurance companies to categorize and explain the reasons for claim denials. Some common denial codes include CO 4 - missing modifier, CO 16 - missing information, CO 18 - duplicate claims, and PR 204 - service/treatment not covered by the current plan.
Claim denials in medical billing are categorized into hard denials and soft denials. Hard denials cannot be reversed, and the provider has to write off the payment. It results in revenue loss. Whereas, soft denials can be revised, resubmitted, or contested for reversals, and the provider may be able to collect the amount due.
If a medical claim was denied because of incorrect or missing information, the payer will flag the claim with denial codes CO 4, CO 11, or CO 16. Healthcare providers can fix the errors and fill in the missing information to resubmit the claim for accurate reimbursements.
If the payer denies payment because the services were offered by an out-of-network provider, were not covered under the insurance plan, or the claim was submitted after the due date, then this will be considered a hard denial. Hard denials are usually flagged with denial codes PR 242 - out-of-network provider, CO 96 - for non-covered services, and CO 29 - claim submission after the deadline, and cannot be appealed.
