The rate at which medical claims get denied by insurers is pretty concerning. According to a recent analysis, the average claim denial rate increased by 23% compared to four years ago. For medical practices, this means unpaid services, resulting in lost or delayed revenues, hurting the financial health tremendously. <\/p>\n
But before you blame insurers for denying your claims, take a step back and look at your denial management strategy. The fact is, most denials result from wrong information or misinformation in your claims, forcing the insurer to interrupt your revenue flow. What’s more perplexing is that not all organizations commit to following up their claim denials, leading to unfavorable resolution or abandonment, which eventually causes the claims to be written off as bad debt. <\/p>\n
Good news: you can increase your organization’s claim acceptance rate to 95% or better by implementing a solid denial management https:\/\/clinicaldocs.mystrikingly.com\/<\/a> strategy. Curious to find out more? This in-depth resource takes a deeper dive into the basics of denial management, including: <\/p>\n In a word, denial management is a strategic process that aims to unmask and resolve problems leading to medical claim denials. But that’s not all; the process should also mitigate the risk of future denials, ensuring that practices get paid faster and enjoy a healthy cash flow. <\/p>\n The denial management team is tasked with establishing a trend between recurring denial reason codes and denial reason codes. The goal is to point out the registration, billing, and medical coding setbacks through trend tracking and correct them to prevent future denials. The team also analyzes the payment patterns for individual payers so that it becomes effortless to detect a diversion from the normal trend. <\/p>\n In the section above, we’ve given a sneak peek or the general idea of how denial management works. Now it’s time to dive a little deeper and get the facts right in a systematic technique called the IMMP process, which stands for www.praxis-rosianu.de<\/a> Identify, Manage, Monitor, and Prevent. <\/p>\n The first step to an effective denial management process is identifying the root cause and reason for claim denial. Please note that when the insurer denies a claim, they usually indicate the reason in the accompanying explanation of payment. These indicators are better referred to as claim adjustment reason codes (CARC). <\/p>\n The real assignment lies in interpreting the insurer’s feedback and determining the actual reason for claim denial. Unfortunately, deciphering the CARC usually takes time and requires top-level skills, considering that some insurers still use the non-standard, legacy codes that are overly confusing. But with dedicated denial management professionals, your organization should identify why a claim wasn’t reimbursed and who’s responsible for the payment, as it’s a critical step in getting the insurer to compensate your organization for the claims. <\/p>\n After successfully identifying the reason for claim denial, it’s time to resolve the denial, i.e., get the medical claim paid by your insurer. The denial management team can accomplish that feat by implementing the following actions: <\/p>\n The first action involves organizing and speeding up the paperwork for denial-related info. That means using automated tools to route denied transactions directly into worklists. For instance, you want to route all coding-related denials to your coders for them to quickly and efficiently act on each item. <\/p>\n Here, the denial management team employs sophisticated software to sort their worklists by amount, time, reason, among other factors. This makes the team’s work more streamlined and [empty]<\/a> efficient, unlike using manual systems. <\/p>\n The third action involves creating a standard action for each type of denial by: <\/p>\n Do you want your denial management process to be as systematic and error-free as possible? A checklist can help! Creating a simple checklist of do’s and don’ts can help your team avoid common mistakes that cause denials to stagnate or become uncollectible bad debts. <\/p>\n <\/p>\n\n
What is Denial Management?<\/strong> <\/h2>\n<\/p>\n
How Does Denial Management Work?<\/strong> <\/h2>\n<\/p>\n
Identify<\/strong> <\/h3>\n<\/p>\n
Manage<\/strong> <\/h3>\n<\/p>\n
1. Routing Denials Directly<\/em><\/strong> <\/h5>\n<\/p>\n
2. Sorting the Work<\/em><\/strong> <\/h5>\n<\/p>\n
3. Creating Standardized Workflow<\/em><\/strong> <\/h5>\n<\/p>\n
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4. Using a Checklist<\/em><\/strong> <\/h5>\n<\/p>\n
Monitor<\/strong> <\/h3>\n<\/p>\n