Denials nullify the growth and revenue stability of health organizations if left unchecked. An organization's operational efficiency largely depends on a streaming cash flow, and denials can negatively influence it.
While the industry benchmark for claim denials is 2% for hospitals, very few organizations are able to maintain that level. As vendors, BillingParadise in the past many years has partnered with with several health organizations, lending them efficient denial management support.
We’ve come across situations, where an organization’s denial had touched 15-20%. After the denial management team of our company reworked on these denial claims, we were able to get 90% of these cases successfully processed by payers.
Similarly, a 200-bed hospital had written-off 3% of its net patient revenue, and the write-off revenue totaled $2.5 million a year.
We assigned our denial management team to review each of the write-off cases, while 30% of the denials could not be appealed, because time had lapsed. The other 70% were successfully appealed, again 90% of the claims were successfully processed and reimbursed by the payers.
BillingParadise, with a decade of revenue cycle management experience can make a huge difference to the denial management operations of a health organization.
Our team of certified billers and coders use top-of-the-line tools, analysing payer adjustment codes from remittance advice to successfully appeal denied claims.
The proven experience of our knowledgeable staff will help your organization expeditiously resolve underpayments that are inconsistently interpreted in contracts, policy, or documentation.
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 amazingcharts.
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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