Denial Management and Prevention

Denial Prevention and Management

Claim denials greatly impact the revenue cycle by delaying or reducing payments from payors to providers. They can occur for many different reasons, even if the smallest error is made. While denials can cause a significant amount of revenue loss, most of them can be avoided. Taking steps to prevent them, therefore, is worth the time and investment for any size Practice Group, MSO, Hospital or Health System.

Denials come in many shapes and sizes. What needs to be understood is that they are not objective. Denials are simply the result of a rules-set, programmed within the payor system to look for matching information in a myriad of patient and contract databases. Missing information and/or improperly coded claims from a data processing viewpoint is simply a mechanism in the programming language to reject a claim. The programs that pay on a clean claim, don’t distinguish your particular claim from any other, regardless of the information in question or the amount.

While ReMedics goal is to prevent denials from occurring altogether, we provide our clients with the right workflow efficiency tools to quickly get them appealed and resolved. We also ensure that the process is managed and audited to stop recurring denials — with reporting & analytics tools to help identify the root cause of problem areas.

Automated Data Validation and Workflow

Data validation is at the heart of ReMedics Denial Prevention. Validation helps to scrub and cleanse the data before posting. We automatically check for errors, validating all claim information needed for processing while improving data integrity. Once data is captured (EDI or paper), our payment validation process begins applying over 180 client customized rules to find potential cash application errors before posting and routing those errors back to work queues for correction. Payment validation verifies batch control totals, compares payment transactions (with patient import files) and routes exceptions to our operations team for correction. This automated workflow and data cleansing technology significantly reduces denials, posting errors and reprocessing.

Denial Management 

Working in tandem with our proprietary Payment Processing technology, our Denial Management application captures denials in the system and then routes them for automated correspondence and work queue follow-up. Depending on your specific requirements and staff assignments, we provide our clients with efficient worklisting tools that include claim and patient information, along with links to relevant documents such EOBs, correspondence, and checks. By having a single source of denial information and correspondence, we create efficiency in your billing office and accountability for managing all denials.  

Denial Analysis Scorecards

ReMedics Denial Analysis Scorecard provides the tools you need to help identify the root causes of your most costly denials; denial patterns and trends; process breakdowns; financial impact of denied claims; delayed payments and partial payments; effectiveness of your follow-up resolution procedures; and areas for improvement in the business process.

Practice Group Denial Management Scorecard

Denials trends can be analyzed and traced to specific areas, from patient access and eligibility to individual physicians, departments or type of service.

Customized to your practice needs, this report shows denials by facility, payors, denials types, denial category, dollars by denial type, last activity and much more. By providing a complete record of all denials, with Power BI drill-down capabilities, we provide valuable insight into where errors are more likely to occur in your claim and billing processes. By taking a proactive approach to Denial Management, cash flows are increased, and overall cost to collect is reduced. 

Let’s talk about how we can help to reduce your initial denial rate altogether and help to make appeals more efficient for your organization. Contact ReMedics today to get started.