Outsource Denial Management Services

Denial Management to Optimize What You Deserve





Minimize Claim Denials and Sustain Revenue

MedBillingExperts has over 10 years of experience in handling denial management needs of healthcare providers from the largest health systems to independent practices. Leveraging this experience, we have designed a carefully crafted workflow that lets us drill through the data and uncover the root cause of all denials. Once we understand the issue, we create a detailed report that highlights new as well as recurring reasons for denials for individual categories such as physician, payer, diagnosis and CPT. Based on this information, we implement process improvements that eliminate denials and optimize revenue.

10 years of experience denial management company in USA
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We Help You Better Manage Denials. Here’s How

  • Help healthcare providers recognize opportunities to identify and correct issues that cause claims to be denied by insurance providers
  • Classify denials by source, reason, department, and other distinguishing factors to simplify the denial management process
  • Implement innovative denial management strategies that engage patients and physicians to effectively appeal and reverse unsubstantiated denials
  • Develop and evaluate different denial management strategies for effectiveness and efficiency
  • Ensure up-to-date knowledge of the different windows that different third-party payers require to file insurance claims to prevent future denials

Our End-to-End Medical Denial Management Process

Identifying Key Denial Reasons

Our claims denial management service starts with identifying the key reasons for denials

Categorizing Denials

This step not only enables us to monitor and route denials to the appropriate department for remediatione

Establishing Tracking Mechanism

Once we categorize the reasons for denial, we get to the business of developing a tracking/reporting mechanism

Monitoring and Preventing

In this stage we make sure that all claims are monitored and assessed to prevent repetitive revenue leakage.

Denial Management Services We Specialize in Include

Interpreting Denial Patterns

Our experts identify the root cause of denials by collecting and interpreting denial patterns. Once the denial patterns have been collected, they are analyzed and quantified to gauge their financial impact on the organization. The denial management service patterns are then interpreted to determine where the errors are stemming from and how severe they are. Once the errors have been thoroughly scrutinized that the root cause of the denials are established, and solutions tailored accordingly.

Patient Scheduling and Registration
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Collecting Denial Appeals Data

As part of our end to end denial management services, our team of experts will help you gather information on denial appeals and help you understand where the malaise lies. We also help you collect additional information from the status of the appeals process. Any correspondence with payers will also be gathered to help you determine the outcome of the denial appeals process. We will also establish the disposition of the appeals to help you streamline the recovery process and ensure there if complete recovery of the outstanding amount.

Comprehensive Reporting

Our denial management specialists provide accurate reports to top management that allows them to take better business decisions and prevent future denials. We provide claims processing reports that contain a list of rejections that must be resolved before claims can be forwarded to commercial insurance companies or government payers. Our streamlined denial management in RCM process identifies the root causes of claims denials that put the greatest strain on your practice’s financial performance, thereby accelerating cash flow.

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AR Management

Tracking and Appealing Denials

When you outsource denial management services to us, we also help you, create appeal letters based on state and federal statutes to aid in getting reimbursed for previously denied claims. We also prioritize, track, and appeal denials with case citations that favour the medical provider’s appeals. We ensure that we file appeals within a week’s time of receiving the denial so that there is no lag time or delay in getting reimbursed. Our cutting-edge tracking system logs claims as they go in and out of the appeals system so we are always aware of the status of the claims appeal.

Sorting Denials into Categories

Our team of denial management experts sort denials in medical billing by categories to discover opportunities to adjust workflows, revise existing processes, and re-train physicians, employees and providers. This allows us to identify the categories that have the greatest denials and restructure processes to prevent denials from arising in the first place. We also conduct audits for different categories to put quality assurance processes in place and ensure denials are resolved at the source.

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Identifying Business Process Improvements

Our experts prevent denial from happening by tracking categories and mapping them with the number of denials. Next, we break down each category and drill into the specific processes to identify where in the process the denials are stemming from. Whether the source of the denials is sloppy patient registration or coding errors, we identify the cause and come up with different business process improvements to resolve the problem at the source. This is why we are counted among the best denial management companies in USA.

Our Specialties

Why We Are Regarded as an Industry Authority in Denial Management

Full Compliance


We conform to rigid documentation protocols to meet HIPAA and Office of Inspector General compliance

Stringent Data Security


We ensure that we use firewalls and secure transmission modes for communication such as VPNs, SSLs and encryption techniques

Extensive Training


We provide regular staff training to ensure up-to-date and thorough knowledge of rules adopted by different third-party payers

Rigorous Claims Audits


We ensure frequent and detailed audits of denied claims to analyze the kind of errors made in submitting the claim and prevent further denials

High Accuracy


Our expertise provides our clients with the most accurate denial analysis to help them take quick steps to recover payments from denied claims

Sophisticated Technology Capabilities


We leverage advanced analytics capabilities, to analyze remittances and alert clients on potential denials, hidden problems and realize cash opportunities.

How We Help You Reduce Denials

Determine Patient Eligibility Before Admission

our staff is highly trained to gather every piece of information related to patient's health insurance coverage and quickly

Obtain Prior Authorization

This is one of the unique features that sets us apart from other denial management companies

Reduce Coding Errors

, we have proactively taken several steps such as extensively training our medical coding specialists to cross-check and verify codes

Read Our Clients Latest Reviews

George Biden General Physician, Texas

"We were unable to keep track of denied claims and it kept piling up over time. MedBillingExperts helped us get our process organized so that we could keep an eye on each denied claim and process it with proper corrections. We are thankful to their well-organized process for assisting us get full control over denial management"

Senior Director Second Largest Surgical Center in New York

"Our claims got denied for different reasons and we were at a loss trying to find out the root cause. Thanks to Medbillingexperts we were soon able to establish a denial management process that helped us identify and bucket the common type of denials and weed them out from process."


Denial Management Through Our Lens

RCM Solutions

Our Process

Our complete Denial Management Process

We have a well-defined process to help you get full control over claims denials. Go through the diagram to understand how our denial management service works.

How It Works
Cost Benefit Analysis of Outsourcing Your Medical Billing

Blogs

Denial Management Best Practices for Hospitals

Effective denial management has a major impact on the financial stability of a healthcare service provider. This blog throws more light on how service providers can streamline their denial management process and make it error-free.

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7 Chief Benefits of Outsourcing Medical Billing Services

Case Study

Optimizing AR Management Process for a Renowned Billing Company

Our client was losing out a major portion of its revenue to denials. Consequently, their balance sheet was getting affected severely. We tailored a robust solution to help...

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We helped a Medical Practice Optimize Their Medical Billing Process to Improve Bottom Line

Articles

4 Tips to Avoid Common Mistakes Resulting in Claim Denials

Health care providers are working round the clock for processing claims accurately. However, taking 4 vital considerations into account, can help you reduce claims denials considerably.

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FAQ's on Denial Management

Denial management is the process by which healthcare providers deal with denied claims. Effective denial management helps healthcare providers determine what is causing these denials, avoid denials due to recurring errors, get paid faster, and improve patient satisfaction.

Denial management in medical billing is the process by which physicians and facilities manage denied claims and resubmit them for approval. It consists of many services from AR follow-up and claims status checks to preparing appeal letters and categorizing denials according to the root cause and source of the denial. The entire purpose behind denial management is to collect all the dollars due for medical services rendered.

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There are a host of major sources of claims denials for every healthcare provider. Major denials that are common to all healthcare organizations include coding errors, duplicate claims, and non-covered charges. Other sources of claims denials include untimely claims filing, missing information, and incorrect patient identifier information.

There are many types of denials in medical billing from technical denials to hard and soft denials. A soft denial is a temporary denial that can be erased if adequate follow-up actions are taken by the provider. These denials do not require an appeal. Hard denials are any denials that can result in a write-off or lost revenue for the provider. In these denials, there is a need to appeal. Preventable denials account for 90% of all denials and are basically hard denials resulting from inaction or an action on the part of the provider. Then there are clinical denials, which are denials of payment on the basis of level of care, medical necessity, or length of stay. Finally, technical denials are denials where the payer has informed the provider, through remittance advice, of the reason behind the claim denial. Additional documentation is needed to resolve this type of denial.

The two main reasons behind denied claims are patient ineligibility and coding errors. If the patient is not eligible for care under the terms of their insurance plan, but is provided with medical care for some reason, that counts as patient ineligibility. Coding errors may result from errors in the submitted diagnosis and procedural codes. Outdated CPT or ICD-10 codes can also result in a claims denial.

No, we do not provide on-site denial experts.

A denial FTE is a Full-Time Equivalent denial resource that is available round the clock to help you with your denial management requirements. They will report to you and will be in charge of managing denial management operations under your management.

We have different charges for different types of denial FTEs. To get an idea of the exact numbers involved, simply fill out a short form on our website and we will get in touch with more details shortly.

We ensure 100% HIPAA compliance with federal regulations. Besides this, we guarantee data security, privacy, and integrity.

We have different charges for different types of denial FTEs. To get an idea of the exact numbers involved, simply fill out a short form on our website and Yes, we do have an EHR-integrated denial management system that automates charge capture and claim creation.

Denial management outsourcing can help your business benefit from reduced denial volumes, improved cash collections, greater patient satisfaction, and increased collaboration and communication among internal departments. It can also help you identify the principle reasons behind revenue loss so that you can stop revenue leakage out of your organization.

We can begin operations in as little as 2 weeks. In that time, we will monitor and evaluate how your current systems and processes operate to find an effective way to integrate our services with your existing software and IT infrastructure.

The MedBillingExperts team is always available to answer your queries. Simply fill out a brief form on our website, email us at info@medbillingexperts.com, or call us at 1-866-344-1936 to get a hold of a representative.

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HIPAA Compliance

25%

Increase in Collections

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