Denial Management

Denial management is a crucial part of the medical billing process. It’s all about analyzing, identifying, and fixing denied claims so healthcare providers can get the reimbursements they deserve—on time. This is essential for the growth of your practice and for delivering efficient, high-quality care. To handle denials effectively, it takes a combination of technology, expertise and innovative strategies. At One O’Seven RCM, our experts specialize in denial management. We help to boost revenue, Improving communication and trust between providers and payers and reduce hassle.

Aspects of Denial Management

• Identification of denials, their codes and remarks.
• Checking out the aging reports if any
• Focus on common denials categories like missing or invalid documentation, incorrect coding or underpayments.
• Analyze and categorize the denials by their type and assign responsibility for process improvement.
• After fixing the errors the immediate resubmission is required.
• Usage of different software to detect errors before submitting claims.
• Training of staff on common denials and their management is crucial.

High denial rates are due to various reasons like registration and coding errors, insufficient staff training, technological gap and lack of data analytics. Below are some common denial management challenges:

• High volume of denials due to registration error or missing documentation results in cash flow disturbance
• Varying rules and regulations of insurance panels lead to confusion among staff.
• Lack of professionalism and trainings among staff results in repeated mistakes of denials
• Longer days in AR can caused by manual and insufficient process
• Ineffective strategies while appealing leads to revenue loss even on valid claims
• Denial of claims are maximized if submission is after the deadline of payers.

Mitigations are aligned with industry best practices. Each mitigation is practical and directly addresses the challenges:

• Tracking denials and uses of AI powered tools are mandatory to standardize the process
• To stay update with industry regulations the staff trainings are crucial
• Regular audits and implementing certification programs for billers
• Outsourcing can help to overcome manual process and optimize workflow
• The template for appeals and clinical collaboration help to improve appeals, and the designated team should work to track appeals.
• Automated RCM system to track the deadlines

Your patients deserve your focus—leave the rest to us

The denial management process is complex but prioritizing root-cause analysis and technology the denial rates can be reduced. Our goal is to assist our clients by providing exceptional services. Start your journey with One O’Seven RCM and optimize your financial success!

• Dedicated team

• All hour services

• Transparency

• Professionalism

• 100% Data security

•  Accurate documentation

• Regular updates

• In accordance with HIPAA and Industry standards

• Reduce administrative burden

• Increase cash flow

• Maximize reimbursement

• Innovative and customized solutions