Denials and Appeals
Find the root cause. Address issues. Get paid. Focus on denial prevention.
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Denial Management Services
What is Denial Management in Healthcare?
Denial management is often confused with Rejection Management. Rejected Claims are claims that have not made it to the payer's adjudication system on account of errors. The billers must correct and resubmit these claims. Denied Claims, on the other hand, are claims that a payer has adjudicated and denied the payment.
Healthcare organizations should be concerned about both rejected claims and denied claims. The claims rejection management process provides an understanding of the claim's issues and an opportunity to correct the problems. Denied Claims represent lost revenue or delayed revenue (if the claim gets paid after appeals).
To successfully appeal denied claims, the billers must perform a root-cause analysis, take actions to correct the identifies issues, and file an appeal with the payer. To thrive, a healthcare organization must continuously address the front-end processes' problems to prevent denials from recurring in the future.
Our Denial Management Service Offering
Medical Billing Wholesalers' denial management team has seasoned professionals who:
Investigate the reason for every denied claim
Focus on resolving the issue
Resubmit the request to the insurance company
File appeals where required
We understand that each denial case is unique. We correct invalid or incorrect medical codes, provide supporting clinical documentation, appeal any prior authorization denials, understand any genuine denial cases to pass the responsibility to patients, and follow-up effectively. We re-validate all clinical information before re-submission.
As an extended billing office, we work with you to analyze your denied claims and reduce denial % over time.
Filing Appeals
We analyze denial reasons, prepare appeal letters, and refile the claims by attaching clinical documentation and submit the claims via fax appeals in a payer-specific format.
Reducing Denials Through Analytics
Different component processes within the revenue cycle chain can result in claim denials. Often, denial issues are practice-specific or facility-specific. We understand the trends in claim denials and launch an iterative process to reduce them based on specific causes.
Testimonial
Florida Based Medical Billing Company
“I really appreciate the reporting process followed by the Medical Billing Wholesalers’ team. The report consisting of the TOP 10 reasons for denials and rejection is really valuable & helps to control the practice’s rejection and denial rates.”
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Denial Management Infographic
Benefits of Our Denial Management Services
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Our Denial Management Services are at the forefront of recovering revenue from denied claims. We diligently work to identify, address, and appeal claim denials, significantly boosting your revenue recovery rates.
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By thoroughly analyzing the reasons behind claim denials, we help in refining your billing practices. This proactive approach not only reduces future denials but also minimizes revenue loss and streamlines your billing processes.
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Embrace efficiency with our services. We automate and optimize various tasks within the revenue cycle, minimizing manual errors and maximizing operational productivity.
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Our approach is grounded in analytics. By examining denial patterns, we provide actionable insights that help in making informed decisions, improving your overall billing strategy.
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By partnering with us, you're not just improving your revenue cycle efficiency; you're also choosing a cost-effective solution. Our Denial Management Services lead to significant cost savings by reducing denials and optimizing your overall revenue cycle.
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Navigating the complexities of healthcare regulations can be daunting. Our services ensure that your claims are compliant with current regulations, reducing the risk of penalties and ensuring adherence to industry standards.
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We go beyond denial management and shift focus to denial prevention. Contact us to learn how we can transform your revenue cycle management and pave the way for a more financially secure future.