Denial Management Services

Turning rejections into money

Are you tired of dealing with the stress and monetary damage caused by denied claims? Allow us to assist you in converting denied claims into income using our trusted denial management strategies.

Managing denials is critical for a practice’s revenue cycle success. A denied claim has two financial considerations: lost revenue from insufficient prior authorization and the expense of appealing and reworking the claim. Recent research shows that doctors incur costs between $30 and $100 or higher for fixing a claim, leading to an annual practice expense of $14,400 (the minimum estimate) with 40 denied requests monthly, without factoring in the initial claim submission cost.

Avoiding denials is preferable to having to redo them, but this can be challenging for many practices because of constraints in staffing, time, and resources. We provide comprehensive denial management services to increase revenue and reduce administrative tasks.

We start our proven process by conducting a detailed assessment of low-pays, no-pays, and current denial trends to pinpoint the underlying reasons. Our AR team collaborates closely with our coders to create and implement specialized guidelines that efficiently address coding denials. We also assist your team in putting in place strategies and SOPs aimed at avoiding future denials, reducing AR days, and increasing collections.

An effective system for handling denials

Healthcare’s denial management approach is based on monitoring, classifying, and evaluating. This is a summary of the usual stages in our denial management procedure:

Classification: We categorize denials based on their type, assigning a specific denial code to each one. Our classification identifies and catalogs typical rejections.
Examine: Our specialists perform root cause analysis to identify trends within each denial category and address them promptly. This includes assessing claim information and reports, interacting with staff involved in the claims process, and evaluating payer policies and guidelines.
Fix: Once we pinpoint the underlying reasons for denials, we make the required changes. This includes making updates to policies and procedures, changing coding practices, and enhancing documentation practices to prevent and eliminate these denials from occurring again.
Revise and Submit Again: Next, we submit the rejected claims with the required corrections and supporting documents. At this stage, our AR team meticulously attends to every detail to ensure the accurate inclusion and submission of all necessary information.
Follow-up: After resubmitting claims, we consistently follow up with the payers to ensure proper processing and provide you with ongoing updates on the status of the claim. Discover how our exclusive software assists you by providing real-time updates on claim status and eligibility confirmation.
Appeals: If a claim is denied again, we provide more information or evidence to support it and work with the payer to argue for it.

Our group of experts consistently keeps track of and produces regular reports on the denial rates, resubmissions, and appeals status. We need to make sure that we fully understand the instructions before starting the task.

Benefits

Why partner with Healthcare Services?

Our comprehensive denial management services cover everything from claim tracking, analysis, and follow-ups to appeals management and reporting. We work closely as an extension of your back office, ensuring seamless integration with your existing systems and workflows, and providing ongoing training and support to ensure continued success.