Many health organizations seldom pay attention to setting up a strategy for denial management. The lackadaisical attitude sees denials being unfavorably resolved and neglected, and which over a period of time is written off as bad debt. This, despite studies revealing that 80% to 85% denials can be recovered.
BillingParadise with proven experience in denial management, and a successful claim resolution approach has favorably turned the corners of many health organizations.
We use the most updated systems and technologies for all streams of revenue cycle management, especially for denial management. Our analysts and data scientists use customised analytic tools that provides us with valuable data to help us determine the root causes of denials.
The understanding of billing codes, diagnostic codes, modifiers, and basic demographics is the key to a successful denial management program. Our certified billers and coders are comprehensively qualified to deal with any kind of claim denial eventuality.
The claim denial process begins with identifying the root cause, generally the verification starts with patient access and registration. Any billing/coding errors are referred to the certified coders for eliminating inconsistencies. Insufficient documentation are referred to the billing department or providers for quick resolutions.
Our denial management team constantly receive updates on any regulatory changes. We share payer bulletins with each member of the denial management team for implementing any regulatory changes.
We use data as the core element for a successful denials management program. The denial management team is encouraged to use analytic reports for setting up action plans for an efficient and successful denial management program.
All denials are routed to the denial analysis department. Denials are segregated into line item and full denials
DenialAnalyzer, our denial management and reporting app, gives you realtime insights
All claims are categorized into different follow-up groupings.
We work with all federal and commercial payers and have strong knowledge of their payment mechanisms
Redundant processes are automated. This cuts back on cycle times. Recover money faster.
Software that identifies, isolates, quantifies and categorizes denials to help you lower your denial rate and spot revenue leakage sources.
This is what sets us apart
||Your Denial Provider|
StatsBefore we delve into processing denied claims, we need to know the initial denial rate, dollar rate, and claim rate. This will help us lower denial rates, and improve the process.
Organized ProcessLosing track of the denied claims will lead to diminishing revenue. If the number of denials keeps increasing, it will lead to revenue loss and severe administrative problems. Thus, an organized denial management process can help track all claims, using HIPAA certified tools and technologies.
Denial TrendsQuantify and categorize the denials by tracking, evaluating and recording the denial trends. We consult your physicians and payers for information. This helps reduce claim denials and improve compliance. We also use data and analytics to collate and find reasons for claim denials, and identify core issue to rectify them.
Completing denials within 24 to 48 hoursWhenever a claim is denied, we follow a validated process to get the denial corrected, preferably within 24 to 48 hours. This is made possible by following an established workflow which will track the claims as they enter and leave your system.
Quality and quantityOur 24 hours active resources enable us to provide resolution through analysis and calling. This helps segregating quality claims, while eliminating claims that do not need to be resubmitted. .
Tracking the progressThis is one of the most important aspects of denial management. It helps to know which areas are doing well and which need further improvement. Both the wins and losses will be documented for future analysis and improve the systems efficiency. Automating denial management processes also give plenty of time to rework on rejections.
Now you need never miss a single cent! Our denial management experts view the ERAs/EOBs posted in the patient advisory screen of GE centricity emr.
We have an extensive payer rules checking engine that checks claims against payer rules.
We follow a cross functional strategy to analyze and categorize claims based on reason for denial and rejection pattern.
As our denial management support is available 24/7 you can be sure that the window never closes on any claim.
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