An effective and efficient management of denials entails setting up a process of collecting, tracking, reporting, trending, forecasting, and measuring data. These elements help in managing revenue loss.
It is not in the realm of health organizations to set up such an effective revenue management structure, given that patient care is their top priority, and any drawback on care would mean a drop in revenue of the organization.
Denial claim management is better left to a professional billing company, which is adequately staffed with certified billers and coders, and with access to reporting and analytic tools.
BillingParadise, with a proven experience of 10+ years in revenue cycle management has partnered with notable health organizations, lending them denial management support. All billers and coders of our company are certified, with years of experience working in tandem with payers and providers.
We follow the best practices in revenue cycle management, with denial claims routed to work queues assigned to the denial management team. Beginning with establishing denial management strategies, the team foremost identifies the root cause for which the claim was denied.
The team categorizes the identified reasons, and based on the experience of billers and coders working with specialties, denied claims are distributed for corrective actions. After the inconsistencies in the claims are corrected, they are resubmitted to the payers.
An effective tracking mechanism has been developed by our company to track the status of the resubmitted claim, with a staffer dedicated to follow them diligently.
BillingParadise also provides a checklist to the health organizations, detailing top denial reasons, and how this can be prevented for filing future claims.Claims scrubbing report - Request one for you!
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 prognocis 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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