Denial Management

What is Denial Management in Healthcare?

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.

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.

Denial management is often confused with Rejection Management. Rejected Claims are claims that have not made it to the payer's adjudication system on account of errors. The billers must correct and resubmit these claims. Denied Claims, on the other hand, are claims that a payer has adjudicated and denied the payment.

Healthcare organizations should be concerned about both rejected claims and denied claims. The claims rejection management process provides an understanding of the claim's issues and an opportunity to correct the problems. Denied Claims represent lost revenue or delayed revenue (if the claim gets paid after appeals).

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To successfully appeal denied claims, the billers must perform a root-cause analysis, take actions to correct the identified issues, and file an appeal with the payer. To thrive, a healthcare organization must continuously address the front-end processes' problems to prevent denials from recurring in the future.

Our Denial Management Service Offering

Medical Billing Wholesalers' denial management team has seasoned professionals who:

Investigate the reason for every denied claim Focus on resolving the issue
Resubmit the request to the insurance company File appeals where required

We understand that each denial case is unique. We correct invalid or incorrect medical codes, provide supporting clinical documentation, appeal any prior authorization denials, understand any genuine denial cases to pass the responsibility to patients, and follow-up effectively. We re-validate all clinical information before re-submission.

As an extended billing office, we work with you to analyze your denied claims and reduce denial % over time.