Outsource Denial Management Services

Our End-to-End Medical Denial Management Process

Being a leading denial management outsourcing company in the industry, we follow a meticulous and well-defined process for accelerating the repair and re-submission of denied claims. This can be outlined as follows:

1. Identifying Key Denial Reasons

Our denial management outsourcing services starts with identifying the key reasons for denials. In this process, we first carefully analyse the status codes and the reasons for the remittance returned by the payer. Simultaneously, we also carry out a complete examination of your medical billing procedures and management to understand the hidden reasons behind constant denials. Once this is done, our team of industry veterans leverages their expertise to fix the issue within the shortest possible time and ensure constant flow of revenues into the organization.

2. Categorizing Denials

After getting a clear picture of the volume and reasons for denials in a practice, we initiate the second phase of categorizing the denials. This step not only enables us to monitor and route denials to the appropriate department for remediation, but also helps us to adjust workflows, identify opportunities to revise processes and so on.

3. Establishing Tracking Mechanism

Once we categorize the reasons for denial, we get to the business of developing a tracking/reporting mechanism that enables us to retrieve following information:

• Top denial categories affecting the practice
• The hardest hit department/service areas by denied claims
• Top payers impacting the organization in terms of claims dollars denied

4. Monitoring and Preventing

This the last phase of our outsourced denial management services wherein we make sure that all the claims are monitored and assessed to prevent repetitive revenue leakage.

Strategies that We Employ to Reduce Denials

Some of the key strategies that we employ to maintain our edge with regards to standard denial management outsourcing companies include:

1. Determine Patient Eligibility before Getting Admitted

At MedBillingExperts, our staff is highly trained to gather every piece of information related to patient's health insurance coverage and quickly use an in-house practice management system to verify eligibility even before the patients get admitted.

2. Obtain Prior Authorization

We have meticulously analyzed the prior authorization requirements for every in-house service and have put together a process that ensures your schedulers get prior authorization for every service that requires it. This is one of the unique features that sets us apart from other denial management companies.

3. Reduce Coding Errors and Determine Medical Necessity

With the transition to ICD-10, there has been a significant increase in number of coding errors leading to more denials. To keep a tab on this menace, we have proactively taken several steps such as extensively training our medical coding specialists to cross-check and verify codes before submitting each claim.

Also, many a times, claims get denied due to the mismatch between diagnosis code and the service provided. To avoid this situation, we have employed a software that edits charges for coverage determinations. We also keep a tab on the policies regarding medical necessity from every insurer and make sure that we adhere to them at all times.

4. Prompt Follow-up on Denied Claim

Our extensive coverage on denials entails regular follow-up and real time status updates, allowing us to resubmit the claims even before receiving detailed denial report via emails by the insurance providers.

This approach allows us to greatly reduce the turnaround time and enable us to deliver faster denial management services with quick payments and hassle-free customer experience.

5. We Don't Assume the Insurance Company is Right

We appreciate the fact the insurance company may not get it right all the time when it comes issuing denials vowing to a variety of reasons. Hence our team always keeps a tab on every unclaimed revenue report and appeal denials whenever warranted.

Why Outsource Denial Management Services to MedBillingExperts

When you outsource denial management services to an expert denial management company like MedBillingExperts, you can reap following benefits:

• Identify the root cause of denials: Our outsourced denial management services give you an opportunity to collect and interpret patterns to quantify denial causes and their financial impact
• Maximize cash inflow: Our seamless reporting process identifies the root causes of denials which are putting the greatest strain on your practice’s financial stability, thereby giving you an opportunity to rectify mistakes and maximize cash inflow
• Provide accurate and timely statistics for management/client: Unlike other denial management companies, we provide access to management analysis reports and other information that can go a long way in preventing future denials
• Track, prioritize and appeal denials: Leveraging our years of experience in the industry, we can aid in the creation of appeal letters based on federal and state statutes as well as case citations favouring our client’s appeal
• Support accurate workflow priorities and scheduling for follow up: We can help you in gathering information on denial appeals, including status, escalation, correspondence with payers, and the disposition of the appeals to streamline recovery process
• Avoid out-of-timely filing
• Analyse the effectiveness of the resolutions
• Identify business process improvements to avoid future denials
• Automate workflow for better efficiency
• Reduce controllable write-offs
• Reduce turnaround time
• Provide complete security of confidential patient information
• Reduce compliance issues