How do Denials Impact my Reimbursement?

Denials management is a critical, yet challenging part of the revenue cycle management process.  Knowing how many denials are occurring and the denial reasons is an important step towards improving the denials process.  It is also important to monitor denials and their causes through denial reporting to make improvements in the revenue cycle.

Understaffed or high turnover in-house billing teams find it challenging to accommodate the denial management work into their regular workflow. They are usually burdened with the regular revenue cycle management work.

Claim denials are one of the main reasons your reimbursement is lower than expected. Of course, ensuring clean claims on the first submission is the key to steady cash flow. Also, having subject matter experts on the billing team to handle the different stages of the denials and appeals process is critical as well.   We know that all denials are not the same.  Below are a few tips to assist with denials management:

Common Denial Reasons

Some of the most common reasons for denials are:

    • incorrect patient demographics or insurance information
    • wrong or lacking insurance verification data
    • credentialing issues
    • authorization issues
    • coding errors
    • medical necessity or lacking clinical information

Once the most common denial reasons are identified, we all have a better understanding of repetitive mistakes occurring in your regular workflow. Making the necessary changes in your billing pattern once you know the points that need attention.

Timely Filing Deadlines

  • It is important to keep timely filing and appeals deadline in mind at all times.  Every payor has a different deadline.
  • Often, clean claims end up in denials due to claims submission delays. While paying attention to timely filing, it is also critical to ensure that the data being submitted is accurate and complete.
  • Having a system where denials are assigned to the respective teams or team members is very beneficial for the organization’s efficiency.

Appeals Process

  • Review claims carefully to ensure that information is correctly completed on the claim form.  If any information was inaccurate, be sure to correct and send a corrected claim. .
  • If the claim is denied incorrectly or requires additional information, you must prepare an appeal letter to provide further explanation.

Hopefully this information regarding denials management is helpful to you and your practice.   What other information or blog topics would be helpful to you? Let us know in the comment section below. We will get back to you. Subscribe to our blog by using our Contact Us Form to know more about current revenue cycle management issues, and healthcare consulting topics.

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