How Denial Management Helps You To Lower Your Claim Rejections

How Denial Management Helps You To Lower Your Claim Rejections

As a healthcare practitioner in the US, you know how denied claims are a regular feat in medical billing and claims processing. However, this issue can be sorted out in the very first stage of claims processing i.e. when the claim is first being made for the payer. But if somehow there is a mistake in editing, putting in records, mismatched numbers, or any other coding error, it can lead to a significant loss to a practitioner.

What Happens If The Claim Is Rejected?

Because here’s the thing, when a claim gets rejected, the chances of getting improved claim reimbursement decrease. The best practice in this situation is to identify the claim denial, and the reason why it got denied, fix the error and send it back to the payer so that you can get your reimbursement.
However, some practitioners take their ‘due time’ to fix these errors. The downside to fixing denied claims is that it also decreases the chances of getting maximum reimbursement from the payer.

Common Types Of Rejection Errors

When it comes to claim denials, there are some common types of medical billing errors that are repeated more frequently and are overlooked by the billers again and again.
  1. Registration Errors
  2. Limited Coverage
  3. Late Submission
  4. Duplicate Claims
  5. Unauthorized Claims
Common Types Of Rejection Errors

Registration Errors

This is the most common type of error that causes claim denials. These errors consist of having an issue with the patient’s name, ID card number, date of birth, address, or anything that is commonly asked during the registration process. If a number, digit or anything is misplaced or incorrect, the claim gets denied and is sent back to the practitioner.

Limited Coverage

Sometimes the insurance company (payer) doesn’t cover certain diseases for their patient. In this case, when the claim for a certain disease is filed and sent to the payer, it often gets rejected. A common reason for this rejection can be the limitations of the patient’s insurance plan.

Late Submission

Sometimes there are no medical billing errors and still the claim gets rejected. One of the reasons is that the practitioner takes too long to submit the claim i.e. probably around 90 days (the number of days varies from company to company). When the claim is submitted later than the allocated time frame, it gets rejected.

Duplicate Claims

Most practitioners also don’t get their reimbursement because their claim gets rejected by the payer due to an error in their system. It can either be intentional or unintentional. Mostly it’s due to slow systems, negligence of the staff, or any other technical error. In the case where the company receives more than one claim, it rejects it.

Unauthorized Claims

Before sending in the claims to the insurance companies, some of the payers require the practitioners to first authorize the claims from them before sending them in for payment. So when a practice fails to comply with this rule and sends the claim without authorization from the payers, the claim gets rejected.

What is Denial Management?

As mentioned above, claim denials can be a headache for a practice and can cause significant revenue loss for a practitioner after delivering services to their patients. Most practices that claim denial issues are very serious and hence, establish a management team (or even ask their billing team) to minimize errors and claim denials.
The denial management team goes through a certain process to identify how and where the errors most commonly occur in their claims and try to fix them before they’re submitted to the insurance companies.

How Denial Management Reduces Claim Rejections?

Most of the denial management authorities follow a series of processes in order to eliminate the claim issues:
  1. Understanding The Root Cause
  2. Setting Up A System
  3. Proactive Approach
  4. Outsource Your Denial Management
How Denial Management Reduces Claim Rejections

Understanding The Root Cause

The first and foremost step is to identify why the claims get rejected in the first place. Identifying the real reason helps the denial management department to streamline their fixing procedure in a better way.

One more thing that adds up in this process is to convey to the patient how their claim has been rejected by the payer. Since the patient’s insurance policy can be directly linked to the claim rejection, it’s important to inform the patient clearly about the current reimbursement situation.

Setting Up A System

Manually searching and inspecting each one of the rejected claims can be exhausting, tiresome, and tedious. And since it is a manual process, chances are that rejected claims can still get overlooked and passed on without any notice. Hence, one of the best denial management strategies is to set up a system (preferably an automated system) that can help you catch denied claims easily and efficiently. In order to deploy efficient systems, you can find various tools and software that can detect denied claims instantly and inform you so that you can take necessary action.

Proactive Approach

Since we’ve discussed how some of the claims are denied solely because they’re submitted late, it’s important to have a proactive approach when it comes to processing claim denials in order to not fall behind the claim deadline. Since most insurance companies give an average period of 90 days to process the claim (if denied), it’s better to prepare for analysis, and when a claim reaches back to the practitioner, start acting so that the claim can be resubmitted before the 90-day deadline.

Outsource Your Denial Management

We understand it can be too much of a task for your medical billing team to create, manage, send the claims, and then fix the denied ones. That is why it is a better, viable, and efficient option to outsource the medical billing and denial management process to a company that is expert in handling it.

That is why you need to know about MaxRemind Inc. and its outclass services as medical billing, coding, credentialing, and denial management services. With a tremendous 20 years of experience, MaxRemind has specialized in delivering excellent medical billing and coding services, generating over 23% increased revenue for its existing clients.

Not just medical billing, MaxRemind also focuses on providing top-notch healthcare revenue cycle management, claim scrubbing, AR recovery, and more. So without losing any more of your precious revenue, try MaxRemind Inc. for your denial management outsourcing today!