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Tips for an Effective Claims Denial Management Audit

Tips for an Effective Claims Denial Management Audit

According to the American Medical Association (AMA), 25 to 30 percent of the country’s total health care costs are direct transaction costs and inefficiencies associated with the “claims management revenue cycle”. Increasing proficiency and improving collection should be top priorities for health care providers with mainly focused on improving prior authorizations and eligibility before an episode of care.

Denial of a claim is the refusal of an insurance company or carrier to honor a request by a provider or an individual to pay for healthcare services received from a healthcare professional. The costs associated with not following up on a denial claim can impact bottom lines and cause severe inefficiencies within a provider’s claims management revenue cycle.

Tips for an Effective Claims Denial Management Audit

Initial Claims Submission

Many providers are not aware of the total number of claims denied initially. In an audit, this is among the first topics assessed and discussed, and providers are shocked by finding that initial denials represent about 10 to 15 percent of providers or a hospital’s total revenue.

Necessity of medical and absence of authorizations are the most common reasons behind the claim denials. Providers can take help of software in their practice that will allow them to check for medical necessity checking, as well as authorizations and eligibility at time of registration and scheduling. Eligibility and authorization software are also available and are often presented as interfaces that are added into health care information systems (HCIS) with support services through a third-party vendor.

Standard Features of EHR System

Most providers have no idea about a standard feature, such as claim validation, that is a part of their EHR system. Have you checked with your EHR provider company? Not yet, check and study this important feature. Many times, most of these features are not called out in a standard implementation or software upgrade, this is the main reason that most providers are unaware of a system feature or functionality. Providers mainly relied on a back-end clearinghouse to validate claim data.

Denial Impact on AR Days

On an average, denied claims waste almost two weeks in accounts receivables days for every encounter denied. You may surprise to know that how a denial impact on your “Days in AR”.

If you audit your data carefully, you will find that the number of days is much higher than expected. In fact, denials are the root cause for when a provider’s revenue cycle is stuck on reimbursements.

Whenever your claim is denied, you must be manually reviewed and fixed, then resubmit before it has another change to be adjudicated. We at Medisys Data follow all required procedures for denied claims. We first take care that your claims should not denied in the first place. Because we know that any denial claim adds at least two weeks to the average number of days to pay. If you have a high denial percentage (e.g. 12 to 20%) that percentage of revenue is stretched across multiple months before it is paid.

You have a choice, let us do your claims denial audit and we can identify common errors and we will make sure that you will get paid at first instance. Also, we can help to reduce denial percentage, ultimately it will help you to increase in overall revenue of your practice.

Are You Ready to Get Billing?

Want to have an error-free billing and coding expert at your work? You are at the right place, what you need now is a partner who can finish out the rest of the work and make the technology and implementation just as simple. That’s what the best medical billing company like Medisys Data Solutions Inc can do. If you’re ready to get started, schedule a meeting with our medical billing manager from filling out enquiry form from our website!

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