It would be nice if you could spend all of your time and energy on patients and their care, but the truth is that you’re running a business. At some point, you have to pay attention to your revenue cycle, and for many, the biggest glitch in that cycle comes with denials. Having a sound denial management process in place can help you shore up this hole in your revenue cycle, help decrease future denials and help keep your patients and customers happy. Follow these tips to revamp your denial management process and improve your operational efficiency.
The first step to improving your process is to understand why claims are being denied. Your patients probably don’t know why their claims are denied either, so if you have this information, you can help them understand. This will not only help improve customer satisfaction, it could help decrease the likelihood of future claim denials.
Make use of technology to help you keep all of your claims organized. Sometimes, when the denial comes back, it gets lost in the shuffle and goes unpaid. If you have a strong, formal organization process it becomes easier to see which claims still need some sort of attention so you can close up those revenue loops.
Once you have everything organized so that you can keep track of all the processed, pending, denied and paid claims in your billing cycle, institute a timeliness policy. Try to ensure that when you receive a denial, you can have it corrected within a week. This will improve customer relations, but it will also help save you from losing money when the insurance company’s denial appeal time limit runs out.
Keep track of all of the claims so that you can see what instances are successful appeals against denials and what instances are not. By tracking, you have the data to see if there is a consistent problem in your process that you can address, and to show that the changes you’re making are actually improving your outcomes. You should also be tracking the types of denials you get to see if there is a trend there. Common causes for denials include coordination of benefits issues, problems with accident details, pre-existing conditions and typos (such as misspelled names, incorrect birth dates or errors in social security numbers). If one of these types of denials is a repeated issue for your organization, you need to institute a policy of checks and balances to address it.
If this all seems like more than you have time to handle, consider outsourcing the process to a service provider. When you’re looking for a company to handle this, seriously ask if it will increase revenues and provide better customer service. Especially for small offices or medical teams, outsourcing is a better option than trying to handle it on your own.
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