Working with an experienced denial management team has a great impact on denial recovery and workflow efficiency. The bottom line shows a significant improvement once denials get paid, and cash flow increases rapidly.
BillingParadise with an efficient Epic Denial Management team has proven expertise partnering with leading hospitals, and efficiently taking care of their denial management needs.
We process the denial information that hospitals receive in multiple formats from multiple payers. Using smart automation tools, we streamline their process organizing data and going into the root causes of denials
The information we gather from the reporting tools, helps us scrutinize why claims with one particular insurer are rejected more often than others. It also helps us find out why a particular diagnosis code repeatedly results in rejected claims.
In a nutshell, our denial management team identifies reasons behind denials and updates health organizations to work on the best practices that would lead to better clean claim rates. As per HFMA, you should maintain your denial rate not more than 5%. Otherwise you will be in a great mess.
These are conveyed to the hospital’s revenue management team for making necessary adjustments to categorizations.
We follow an established practice of reviewing weekly, monthly, and quarterly denial reports of health organizations. These provide us with valuable information of recent write-offs, facility-specific denial trends, besides service line-specific denial analysis.
First and foremost, our analysis begins by determining the geography and size of the health organization, the denial management team then reviews the payer and patient mix. The team surveys the staffing structure and the available technology the organization currently has.
This gives us a basic understanding of the organizations functionality, before we start processing denials.
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 openMRS.
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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