Denial Management

For most of the medical insurance payers, the rule is “Doubt it? Deny it”. It’s a popular notion that
medical practices are too busy to correct the denied claims and resubmit as appeals to insurance
companies. Which is in the benefit of insurance companies as it saves them considerable amount of
money. Outsourcing your denial management to a medical billing company can help you tackle these
denials and improve inflows. Denial management services of Mircalemed can help your practice reduce
your claim denials as low as five percent. It is important to evaluate the root cause of denials and devise
a strategy to eradicate it. Medical billing company can help practices and physicians design that plan of
denial management to minimize the denials and increase the circumstances of you getting paid.

A simple plan to follow for denial management is:

  • Keep a track of how many times you have to deal with claim denials.
  • This requires knowledge of your billing and practice management system.
  • Two methods can be used to post claims. Depending on the type of system used.

Most practices prefer to use automated system to post claim electronically, whereas practices can also
use the manual system of posting claims. In case of manual system user has to manually enter denied
claims i.e. zero payment remittances. Evaluate the root cause of denial. To reduce such claim denials,
you have to find out the root cause of the claim denial. Nearly half of all claims (48 percent) were
pended due to the submission of duplicate claims (35 percent),lack of complete information or other
information needed to justify the claim (12 percent), or invalid codes (1 percent). Twenty-four percent
of pended claims were due to coverage issues,including no coverage based on date of service (8
percent), non-covered or non-network benefit or service (7 percent), coordination of benefits (5
percent), or coverage determination (4 percent). Other or miscellaneous reasons were the cause of the
remaining 28 percent of pending claims.

Once you find out the root cause of claim, then on the basis of common loopholes categorize these claim denials and finally deploy action plan to eradicate each cause and correct the claims to resubmit the appeals.Having comprehensive details about your claim denials will allow you to focus on the most frequent reasons of denials and in the most efficient way because you will know if it is payer, location, specialty or provider specific and you can use only the resources necessary to reduce your claim denials and increase your collection performance. Monitor your practice’s progress over the time to measure your performance. Denial data is a “roadmap for change” in my medical practice. Practices that follow an actionable plan of denial reporting, are always on a safe side. Because it aides them to make necessary changes in their practices and avoid previous mistakes to boost claim acceptance in the future.These are the few basics of denial management Mircalemed can take care of for you. Our services will help you get paid faster and boost the claim acceptance rate by eradicating the root cause of the claim denial.The main aim of follow-up is to obtain claims status, appeals status, and reason for rejection of claim in case of denial.