Medical claims get denied every day for a variety of reasons. It is important to remember that managing your claim denials can benefit your organization on several levels. Not only will it lead to happier patients, but you will also help your collections rate and even boost your organization’s revenue. Here are just a few ways to have a successful denial management process.
Have Checks and Balances
Divide and conquer! Denied claims should be divided across your organization to different departments. One mistake many organizations make is that they don’t do a well enough job assigning tasks across the board. By having a good system of checks and balances, you can ensure claims are always being processed correctly and efficiently.
Just as is the case with any medical process, you need to remain organized to stay successful. You want to ensure you are always keeping track of your denied claims. If you do not keep track of it, they can accumulate rather quickly, and before you know it, you have a ton on your hands! For this reason, many hospitals are turning to management software to keep track of denied claims.
Monitor Your Progress
Since denied claims can quickly pile up, it is wise to track your progress. Formulate a schedule to review denied claims on a regular basis. It is also incredibly beneficial to set goals for your organization in regards to your denial management process. When you meet with your team, brainstorm with your team of what you want to accomplish so always have something to work towards. For example, you could shoot for increasing your collections rate by a certain percentage.
Understand Why Claims Get Denied
If you are looking to lessen your denied claims totals, you need to understand why claims are typically denied in the first place. For example, a simple name misspelling from a staff member could be the sole reason a claim gets denied. Other common causes for claim denials include PIP applications, pre-existing conditions, and accident details. From the surface, some of these reasons may seem rather minor; however, they could be fundamental issues for your organization. By understanding why claims are getting denied, you should expect an increase in your collections revenue.
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