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Denial Management Processes for Healthy Claims


Revenue Cycle Management (RCM) and Denial Management in healthcare go hand in hand. With better and efficient denial management, US medical billing companies can achieve greater profits. Almost all healthcare facilities and billing companies use EHR (Electronic Health Records), today. It is time to update the RCM technology and software in order to support value-based care while decreasing possible revenue leaks. To avoid such leaks, medical billing companies must stop claim denials from happening. As per the survey conducted by the American Academy of Family Physicians (AAFP), 5 to 10% of hospital claims are denied. Like Mark Weber, Infor’s Senior Vice President of Healthcare Development says, it is essential to implement the best RCM & denial management in medical billing for improved operational efficiency. Let’s follow the following best denial management processes to produce healthy claims:
Implement EHR: As mentioned earlier, most medical billing companies and Providers have implemented EHR. However, there is still 31% of Providers who use manual claims. Handling manual claims is not only time-consuming but also slows down the denial management processes. Therefore, implementing EHR is essential for good denial management in healthcare.
Analyze the Common Denial Patterns: Recognizing the common reasons for claim denials will help medical billing companies to stop them from occurring. Some major claim denial reasons include:
  • Erroneous patient demographics
  • Incorrect charge entry
  • Inaccurate pre-authorization
  • Errors in documentation and credentialing
  • Bundled or non-covered services
  • Duplicate data
Implement Denial Management Action Plan: Once the denial patterns are identified, medical billing companies should work on managing them. They should also implement an action plan to tend to the denied claims. The steps involved in this plan include,
  • Directly route denials – through this step, coding-related denied claims are directly routed to coders while a claim denied by reaching patient benefit max is sent to the guarantor's responsibility.
  • Prioritize – this allows staff, to sort and work on the denials considering various factors such as time, dollar amount, and reason. The top priority claims are given first preference and reminders can be set to avoid last-minute delays.
  • Standard workflow – creating a standard workflow is very important for better denial management in medical billing. To avoid duplicates, staff must take corrective measures by following certain protocols (carefully structured and designed in the workflow.)
  • Create Checklist – To avoid common mistakes, it is essential to create a checklist. It may include, avoid delay, build your case, avoid automatic re-billing, engage patients, request an expert and more
  • Online Tools – with the help of these online tools, staff can create best-case arguments to appeal claims. 
Sometimes carrying out denial management in healthcare in-house could be quite intimidating. Therefore, getting help from an offshore vendor would relieve stress.
About e-care India:
If you are on the lookout for an experienced offshore denial management company, then E-care India will be the best bet. With more than 18 years of providing exceptional denial management services in medical billing, this offshore vendor will increase your revenue. ISO certified and HIPAA compliant, e-care provides topnotch security to its clients. To know more about e-care and its services, log on to www.ecareindia.com.

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