We transform denials into revenue — analyzing root causes, filing strategic appeals, and implementing prevention systems to stop denials before they happen.
Denial management in medical billing refers to the strategic process of analyzing, correcting, and preventing claim denials. A claim denial occurs when a payer, like Medicare or a commercial health insurance company, declines to honor a provider's request to be reimbursed for medical care.
Denial Management is the process of systematically investigating each denial, performing root cause analysis of why each claim was denied, analyzing denial trends to uncover a trend by one or more insurance carriers, and redesigning or re-engineering the process to prevent or reduce the risk of future claim denials.
Many physician practices forgo thousands of dollars annually in revenue through denied healthcare claims. These denials typically stem from a lack of strong denial management policies and procedures.
Though all denials result in your physician practice losing out on money you're owed, they primarily fall under five main categories:
A temporary or interim denial that may be paid if the practice takes corrective action; no appeal is needed to recover this revenue.
A denial resulting in lost or written-off revenue where an appeal is strictly required to overturn the payer's decision.
Hard denials due to practice errors, typically stemming from registration inaccuracies, invalid codes, or insurance ineligibility.
A hard denial triggered by a lack of proven medical necessity. These require strong clinical documentation to appeal successfully.
A type of soft denial where the payer notifies the practice exactly why the claim was denied; corrective action or appeal is possible.
Medquik Solutions automate processes in the denial management cycle to streamline your revenue cycle management by identifying patterns of denials and underpayments from payers. Medquik Solutions is a far more effective way to increase reimbursement than the outdated manual processes that are so common. Schedule a demo today.
