Proactively Preventing Denials for Streamlined Revenue and Enhanced Care

Identify coding issues. Educate Clinicians. Prevent denials.

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Coding Denial Management Services

Improve Revenues by addressing claims denied due to Coding issues

Coding Denials are a significant component of claim denials.  While the most cost-effective mechanism for recovering revenue is to ensure that optimal payments are received the first time a claim is submitted, more than 10% of claims are denied even for well-run revenue cycle departments.

Denied claims require a complete review of the reasons that caused the denials. Denials on account of incorrect coding or other coding issues need a comprehensive process, including retrieving medical records, reviewing the medical codes ascribed, assessing the clinical documentation, performing coding edits in line with payer-specific guidelines resubmitting the claim. The process is labor-intensive and time-consuming, draining the resources of the coding team.  

Medical Billing Wholesalers offers comprehensive coding denial management services to help you manage the labor-intensive process. We also provide coding audit solutions to help you prevent coding denials significantly. 

Did you know? Providers do not resubmit or appeal as many as 65% of claims denied!

Due to the intense resource requirements for appealing denied claims, Providers do not resubmit or appeal as many as 65% of the denied claims. Lack of staff and lack of certified medical coders are the common reasons cited by most revenue cycle administrators. As keeping the lights on takes precedence, the focus shifts to processing newer claims rather than addressing denied claims. 

Our Denial Management Services

Medical Billing Wholesalers brings the advantage of efficient processing, denial management expertise, and offshore price structure to bring you a cost-effective denial management solution. Our training programs for denial management personnel and structured policies and procedures for addressing each denial code helps us identify issues with the claim and manage them effectively to allow you the ability to collect lost revenue. 

Medical Coding Expertise 

For addressing coding-related claim denials, we utilize certified coders with experience in the specific specialty. With their experience and expertise, they can narrow down on the issues, apply the right medical codes – using the suitable modifiers as per AMA guidelines, and apply CCI (Correct Coding Initiative) edits. 

Improve reimbursements and reduce coding denial management with Medical Billing Wholesalers’ expertise in medical coding and denial management.

Testimonials

Florida based Healthcare Centre

“I want to take a moment to thank Medical Billing Wholesalers for their extra hard work and commitment in reducing our Missing Slip inventory. The combined efforts of Offshore and our TVH Team had our Missing Slip Inventory down from 22K to 13K.”

Effectively Combat Clinical Denials and Shift Focus to Denial Prevention

Featured
Creating an effective strategy to resolve Clinical and Coding Denials
Creating an effective strategy to resolve Clinical and Coding Denials

Claim denials, a chief cause of revenue loss to healthcare practices, are rising across payer types. A primary source of denials is on account of coding-related denials. A comprehensive and focused denial management and appeals strategy will help reduce this revenue loss.

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Shifting the Focus from Denial Management to Denial Prevention
Shifting the Focus from Denial Management to Denial Prevention

The adage, “Prevention is better than cure”, does apply to Claim Denials as well. An effective denial prevention program requires an iterative process that includes identification of root cause, finding solutions to prevent the issue from recurring in the future, the institutionalization of these procedures through updates to standard operating procedures, and training the staff on these practices. In this whitepaper from Medical Billing Wholesalers, we bring you a few steps that you can take to prevent denials.

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Denial Management Infographic
Denial Management Infographic

Get the statistics for claim denials and strategies for preventing them in this Denial Management infographic from Medical Billing Wholesalers.

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Benefits of Our Clinical Denial Management Services

  • By leveraging our offshore operations, we offer cost savings of over 50% compared to onshore services. This substantial reduction in costs is achieved without compromising on the quality of service, ensuring you get the best value for your investments

  • Our services enhance the accuracy of clinical documentation and claims, ensuring they meet stringent healthcare regulations. This results in fewer denied claims and a smoother billing process.

  • We aim to not just manage denials, but prevent them. By identifying root causes of clinical denials, we help develop more effective strategies, reducing the frequency of denied claims.

  • Our expertise in handling clinical denials leads to effective recovery of revenue. We meticulously analyze and appeal denied claims, improving the likelihood of successful reimbursement.

  • Leveraging data analytics, we provide insights into denial patterns and trends, informing continuous improvement in clinical processes and billing practices.

  • By managing clinical denials, we free up your healthcare professionals to focus on patient care, leading to better patient outcomes and satisfaction.

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