Strategies play a significant role in Denial Management, and if a health organization doesn’t have one, the bottom line will certainly show a lot of red flags, especially when we are entering a new era in healthcare.
Current estimates suggest that gross charges denied by payers has escalated to a full 15 to 20 percent, and making matters worse, 65 percent of denied claims are never processed.
This has aggravated the denial environment further, influencing even the most efficient facilities, that all along were losing 3 percent of net revenue to denials, but will now see an escalation in claim denials.
The wait-and-see approach that many health organizations adopt to denial management can be detrimental, unless they work towards setting up new strategies.
BillingParadise with a well established reputation in denial management has assisted many health organizations with their denial management endeavors. Using elaborated analytics, we develop custom strategies for denial management that are unique and relevant to the specialty of the practice.
We have a methodical approach to denial management workflows. The denial claims are appropriately distributed to the staff members of our team, weighing their experience and expertise in the realm of specialty processing the denials.
The denial management team thoroughly review and interpret the denial reasons, and follow it up taking appropriate claim correction action. The corrective actions are diligently communicated to the health organizations billing departments, for eliminating inconsistencies in filing future claims.
We pay special attention to notify our billers and coders on policy updates, ensuring that they are current, resubmitting claims.
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
| Recommended | ||
| Workflow | BillingParadise |
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. |
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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. | ||
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Now you need never miss a single cent! Our denial management experts view the ERAs/EOBs posted in the patient advisory screen of cerner.
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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