For medical practices, the efficiency of revenue cycle management is crucial to your success. This means having a claims denial management system that helps to minimize the number of denials and rejections that cuts into your cash flow. The proper denial management services help to optimize your cash flow so that you can improve the overall efficiency of your billing operations.

Steps to Reduce Denials and Rejected Claims

The first step is to understand that there is a difference between a denial and rejection in terms of filing claims.

• Rejected: Here, the requirements have not been fully met or something is wrong with the format itself in terms of the claim. Because of this, the payer has technically not received them because they have not been through the adjudication process. Once the errors or standards have been met, the claim can be resubmitted.
• Denied: Here, the claim has been received by the adjudication department and rejected. If the adjudication board has dictated why the claim has been denied, the practice can file for a resubmission once the corrections have been made.

Admittedly, denied and rejected claims sound similar, but they are two different things in terms of how they can be addressed. Appealing a denial can be a costly process, particularly if there is little that can be done to get it overturned. While most rejections can be successfully and even quickly appealed, there are some that cannot or the information needed to get acceptance is not available.

Review Past Process: You will need to go over all denials and rejections that have occurred in the past six months to a year in order to see the pattern. If such rejections and denials are few and far between, then your healthcare denial management team is doing their job. However, if you are seeing a pattern of denials or rejections, then you will need to address what is occurring.

Reducing Losses: You will need to institute a series of changes in order to catch mistakes so that your revenue cycle management process will return more money

• Proper medical provider information is correct
• Patient information has been double checked
• List right diagnosis or point of service code for the billing
• Match treatment and diagnosis codes
• Learning from past rejections and instituting new polices

You’ll want to look over the process from accounts receivable to billing so that the denial management process is streamlined. The overall goal is to spot any inconsistency or even personnel that are not following the correct process. This may be a matter of additional training, but the results will pay for themselves.

The better you can make the system, the more revenue you will see in your practice. It will require time, patience, and persistence to iron out the issues that may be plaguing your revenue. However, the results will be well worth it as your organization will be better tuned to catch mistakes so that your claims denial management will be vastly improved.