denial medical claims


Majority of healthcare organisations are losing 6-8% of their overall revenue due to payment denials. Denial management sometimes becomes the core issue as to why you are not making profit and are constantly fighting against mismanaged funds and resources. An effective denial management is all that healthcare industry needs to oil the jarring machinery. 

Properly managed claims and denial management hold the key to the financial stability that your company needs. A well functioned behind scene management can help you focus on your core objective and that is patient satisfaction. 

This write-up will help you understand denial management and how it can be addressed in the modern age of technology. 

There are three fundamental ways to effectively manage denials that every healthcare organisation should know:

  1. Firstly, the most important thing to handle denials is to not let it happen! Fundamentally if you are adequately equipped to handle claims then there will not be much errors that could lead to denials. For any organisation the best chance to avoid denials is to avoid denials itself. We need to have a proper check during every step of the revenue billing management which makes the building blocks of medical billing stronger and hence denials can be minimised. Be it during scheduling, pre-admit, registration or billing, every step must be carefully monitored by the experts and the process must be optimised by communicating the progress information with the client and informing them about the changes routinely.
  2. Evaluation

Evaluation is key to forecast and make necessary decisions for all the business people. In healthcare industry if we analyse all the trends and mark out similar denials then we can be one step further in stopping denied claims. To understand the basic problem or the main cause of denials we need to analyse the data culminated by the denial management team. It gives us an understanding of what works and what doesn’t so business decisions can be effectively formulated by the professionals involved.

  1. Trend management and Tracking

For the denial management team to help avoid denials very important job is to understand trends in payments by various payers and close monitoring of all the claim payment pattern to understand what works when everything has worked efficiently in the past. Identifying trends also comes with a lot of experience and with appropriate technology to ensure minimum deviation and in case of any deviance from the successful claims the company is alerted and immediately damage control can be done without making the situation graver.

By ensuring the above three points any setup can make sure to have minimum or no denied claims which is always the first step towards improving the bottom line for any healthcare setup and effective medical billing. It can also ensure that without extreme damage money matters can be handled by simply being proactive and vigilant, so no mistake is made in the first place. 

Now comes the crucial part of manging actual denied claims if there are any in order to maximise your revenue. Denied claims can be of many types and can denied due to big or smallest of deviation from the ideal claims submission. Proper formatting, correct data entry and appropriate time etc could be a few factors that can makes your claims go bad. Here are six important ways to work on your denied claims:

  1. Understanding proper reason for the denied claims

To avoid any future claims, getting denied, having proper information on why your claims were denied is very important, as it can help you streamline your revenue stream in order to maximise profit. If your patients are unaware of the insurance denial system then it becomes our foremost responsibility to make them aware of the entire process for them to not make any mistake and even if they are aware of the system, then also its our duty to make them go through the entire process once again and assist them in any paper work so they can solve any issue. If we help the patient without wasting much time it will reflect positively on our billing process and we could avoid the major work of correcting any mistake ahead. 

  1. Timely reorganization of the denial management process

So many times, we are not able to fill the denied claims on time and due to sheer negligence the account can become cold. In that case to avoid any serious problem in the future we need to keep close eye on the claims that were denied. A good vendor for medical billing which can equip you with the latest technology and tools can help you achieve effectiveness in managing your denials.

  1. Timely claim of all your denials

Generally, the period of one week should be adhered to while filling for denied claims as close monitoring and quick actions can help you track your payment and create an effective workflow. 

  1. Progress needs to be properly followed

Have a regular check on the process leading up to claims and one must always have a clear documentation for denials and unpaid claims in order to streamline the entire process.

  1. Common trends and type of denials should be accounted

Your team must keep a track of all the types of denials that your company faces which can really give you a close idea of the loop holes in your process and then you could combine them to identify trends which can help you not repeat the same mistakes twice

  1. Outsource your Denial management

Manny times your staff is working very hard to make your profit but they are not equipped to handle a multidimensional work like medical billing and which can unnecessary pressurise your hard working staff in that case you must either incentives your staff to help them get motivated for such a  challenging job or get outside help to aid in taking care this complicated process with no confusion and success.

Denial management is extremely crucial for a smooth functioning of any healthcare setup and effective management is the key to ensuring maximum cashflow if your system. All the necessary actions must be taken in order to gain optimally from your business otherwise it will remain a complicate subject matter and delays are not very good for your bottom line.

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