Denial avoidance and denial management.

Preventing and Managing Denials

Preventing and Managing Denials More Efficiently  

It’s no secret that claim denials can greatly affect the revenue cycle and profit loss. While appeals can be time-consuming and costly, it’s better than receiving no reimbursement at all. However, learning from past claim errors to avoid future denials with permanent revenue cycle improvements is the ideal solution going forward.

The first step toward successfully managing denials is in identifying the most common source and types of recurring denials, so that corrective actions can be taken to avoid them. Some of the most common types of denials in medical billing include:

Prior Authorization — Prior authorization when required was not obtained prior to the service being performed.

Insufficient Coverage — Denials can occur simply because the service that the patient received was not covered by their insurance.

Coding Errors — Improperly coding a service can result in a denial from the payor.

Untimely or Late Filing — Simply not meeting the time requirements for filing a claim will result in a denial from the payor. This sounds easily avoidable, but it means being aware of every deadline thrown at you.

Missing Information — Missing the tiniest details of a patient’s data profile, credentialing, or in the pre-certification process may lead to a denial from the payor. Failure to include such information or even mistyping the information often leads to loss of revenue from medical providers.

Denial Avoidance

Eliminating all of the errors in your medical claims are almost impossible to avoid. How these claim defects are dealt with will determine how long significant payments will be delayed – or if they will be lost entirely. For those looking to prevent denials more effectively, outsourcing a portion of the revenue cycle can greatly improve this process.

Using AI and business process automation (BPA) technology, ReMedics Payment Processing platform automatically flags defective claims that need to be worked, so that our Operations Team can make efficient edits and/or include any missing information. 

To reduce future denials, our Reporting & Analytics tools are able to help identify the root cause of common claim defects or reduced payments, ultimately preventing future denials and profit loss.

Managing Exceptions and Denials with Automated Worklists

When exceptions and denials do occur, ReMedics automatically adds them to a client-defined work queue, allowing for timely and effective resolution. Image-enabled worklists create an efficient, user-friendly experience that allows for staff to view every denial needing corrective actions, along with past patient billing information to review and quickly update the claims. Correspondence documents that were received through a lockbox batch are also indexed to the claim and readily available to our clients. 

Choosing to automate this process by utilizing these types of services will ultimately help to make sure that future claims are correctly submitted and provide for timely payment posting.

Talk to ReMedics about how we can help to avoid your denials with fully integrated remittance processing, data validation and bank reconciliation services. Contact us online — or call 440-671-7700.

Originally Published August 9, 2022.