Best Practices for Denials Management in Healthcare

Best Practices for Denials Management in Healthcare

Optimizing and handling Denials management within your practice is the most crucial step in the medical billing process. In fact, according to the American Healthcare Association, the denial rate within a practice can range up to 10-15%. This means this revenue doesn’t count as it doesn’t reach the practice’s bottom line. Fortunately, according to The Advisory Board, almost 90% of the denials can be prevented through proper processing and accurate denials management. In this blog, we will learn how a practice like yours can effectively deploy and operate its denials management to reduce its denials rate and make the most of its practice.

Why Denials Management is Important?

Since now we know that 10-15% denial rates occur in almost every healthcare practice in the U.S., effective denials management can not only get your maximized revenue but also help your practice’s finances, including your expenditure in revenue cycles and reducing various administrative burdens. When there’s less to worry about, you can focus on improving your overall practices and administrative efficiency. With smooth denials management that reduces errors and streamlines workflow, you can eventually focus more on patient care and building genuine relations with them.

Best Practices for Denials Management

Since we’ve been in the field of medical billing and coding, here are some of the best techniques we use to provide the best
results to our healthcare practitioners and providers.

Data Analysis

Most practices overlook this, but it’s important to monitor denials by their volume, type, payer, and denials reasons to recognize the patterns behind frequent triggers. As a practice, you need to know about the essential data points such as the denial percentage on the first submission, the duration from denial receipt to appeal submission, and the percentage and financial value of reworked insurance claims that are paid versus those written off.
The data you derive from here will give you a deep inside look at whether the issue lies in human error, inefficient workflows, outdated technology, or inaccurate data within the practice.
The best way to overcome the ever-increasing rate of claim denials is through regular & thorough audits and precise data analysis. This way you can quickly identify and correct errors, minimizing the risk of future denials.
Data Analysis

Streamline Billing

Optimizing your billing practices starts with the small details. It’s important to submit insurance claims on time, as delays can create unnecessary hold-ups in the entire process. Once claims are submitted, it’s essential to establish a clear procedure for following up on any insurance claims that are pending or payments that are overdue. This system helps ensure nothing slips through the cracks and that every claim gets the attention it needs.

One of the best ways to prevent denials prevention is by taking proactive steps from the start. This includes making sure that every claim you submit is backed by accurate and up-to-date patient information. Before every office visit, confirm the patient’s insurance coverage and verify that all demographic details are accurate.
A quick check of this information before submission can help prevent a lot of issues down the road. It’s also helpful to ask patients to update their insurance details or any changes in coverage during each visit. This way, you’re always working with the most current data, which can make the billing process smoother and more reliable.

Clear Communication

One of the keys to reducing claim errors is staying informed about each payer’s specific guidelines and policies. Keeping up with these details ensures that your claims are submitted correctly from the start, minimizing the chances of errors.
When it comes to appealing claim denials, understanding the specifics of payer contracts and the patient’s coverage-benefit plan is essential. This knowledge allows you to navigate the appeals process effectively. It’s also a good idea to schedule regular meetings with payer representatives. These meetings allow you to address any issues and stay updated on changes to their policies or procedures, helping you stay ahead of potential problems.
Clear Communication
Proper Strategies

Proper Strategies

Having effective denial management strategies is essential for keeping your billing process on track. It starts by maintaining a log of denied insurance claims, which allows you to spot recurring patterns or common issues. Identifying these trends helps you address underlying problems more efficiently.
Creating an organized, structured workflow is key to managing different types of denials. For example, any coding-related issues can be quickly routed to your medical coders, ensuring they are reviewed and corrected promptly. Since most payers have specific requirements and strict time limits for resubmission, it’s important to keep these factors in mind when addressing denials.
Some payers may even require a written rationale for payment before considering a claim. Make sure you document everything clearly—service details, relevant medical literature, and specific references from the CPT code book. This thorough documentation can help strengthen your case when resubmitting claims.

Appeals Checklist

When dealing with claim denials, it’s crucial to ensure that all the right paperwork is in place for an appeal. If even a small piece of information is missing or incorrect, the insurance company might deny the claim again, or worse, cause further delays in the process. To help streamline this, create an accessible appeals checklist for your staff, outlining exactly what needs to be submitted for each appeal. This checklist can include several important items:
  • Any forms specifically required by the insurance company handling the claim.
  • The original Explanation of Benefits (EOB) shows why the claim was denied in the first place.
  • A letter detailing the reasons why the denial should be re-reviewed and appealed.
  • Any service documentation or additional notes that might help clarify or support the claim.
  • Notes from phone calls or emails with the insurer, as these can provide useful context during the appeal.
Having a well-organized checklist ensures that everything is submitted properly, reducing the chances of further delays and increasing the chances of a successful appeal.
Appeals Checklist
Outsource to Experts

Outsource to Experts

One of the best ways to handle your denials management is to outsource your denials management to healthcare industry experts like MaxRemind. MaxRemind, being in the healthcare industry for more than 2 decades, has immense experience and expertise to handle your practice’s denials management effectively. With exceptional services like medical billing, coding, RCM, etc. you can rest assured that your practice is in the best hands.
So if you really want the best for your practice, want to focus solely on your patients, and want to maximize your healthcare revenue cycles, let MaxRemind handle your denials management and other administrative tasks.

Conclusion

Handling denials efficiently is crucial for improving your practice’s financial health and operational efficiency. By implementing the right strategies, such as thorough data analysis, streamlined billing processes, and clear communication with payers, you can minimize claim denials and maximize your revenue.
If managing this process becomes overwhelming, outsourcing to experts like MaxRemind can provide the expertise needed to ensure that your practice remains on track. Let us handle the administrative burdens while you focus on delivering exceptional patient care.
FAQs
What is Denials Management in healthcare?

Denials Management is the process of identifying, addressing, and preventing issues related to denied insurance claims in the healthcare revenue cycle.

Why is Denials Management important for healthcare practices?

Effective Denials Management helps reduce financial losses by addressing common Denials Reasons and improving the overall efficiency of the healthcare revenue cycle.

What are common Denials Reasons in healthcare?

Denials Reasons can include errors in patient information, incorrect coding, or missing documentation, which can be minimized through proper Denials Prevention and tracking.

How can Denials Tracking improve claim approval rates?

By implementing Denials Tracking, practices can monitor claim trends, identify Denials Reasons, and address recurring issues, leading to better claim approval rates.

What is Denials Prevention, and how does it work?

Denials Prevention involves proactive measures like verifying patient insurance details and ensuring accurate coding to avoid common Denials Reasons and reduce the need for Denials Appeals.