How to Effectively Manage Claim Denials | I-Conic Solutions

How to Effectively Manage Medical Claim Denials

Medical claim denials are the most common obstacles to effective revenue cycle management. Most healthcare organizations lose about 6-7% of their overall revenue as a result of payment denials.A major percentage of profit for the healthcare industry comes from medical claims. If an organization pays adequate attention towards retrieving claim denials then a lot of cost cutting could be done when it comes to services.The average claim denial rates for hospitals have risen sporadically to 10% with denial rates rising by more than 20% over the past five years.

It is important for the healthcare professionals to dig out the main reason for rejection of their claim. Understanding the main cause can make them come up with ideal solutions that might resolve their issues regarding the revenue management.

If an insurance company refuses to pay for certain services provided to a patient then it comes on the patient to pay for it and in case that does not happen then automatically the hospital has to bear the losses or file a lawsuit which again might burn holes in their pockets.All of this shall have an impact on the bottom line.

Strategies to Deal With Claim Denials

  1. Outsource Your Denial Management Services:

If a healthcare organization outsources their denial management services then it empowers their employees to concentrate on other tasks and focus more on providing better patient care rather than getting entangled in complicated billings and procedures.The Denial management experts get in touch with patients all sorts of informations required to resolve claims such as benefit coordination, surveys, etc.

  1. Monitor Progress and Success closely:

Hiring a professional medical coder who is aware of the coding requirements, ensures that there is no carelessness and hence keeps a track of  increased rates in claim denials. The coder should be aware of the updated rules and regulations as the billing processes require strict supervision to not affect the RCM of that organization. Hence, it is quite essential to assign a qualified and experienced coding team for this job.

  1. Establish a Standard Workflow for Denial Management Procedure:

It is wise to maintain a common workflow for each type of denial category.all wins and losses should be recorded to keep an account of the unpaid claims. This helps the organization to establish whether or not they have enough personnel working on denials. They should determine the most frequent justifications for denials in practice to develop a uniform approach.

An effective claim denial management system is quite important for a healthcare organization. Every healthcare facility should see to it that they have it covered as it will help them to pay more attention towards providing best services to their patients.

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