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8 Denial Management Best Practices for Hospitals

Did you know that a medical organization loses 7-10% of its revenue on an average? Also, are you aware that if you adhere to the best denial management practices, you can easily avoid the claim denials. The first approach is to directly collect the arrears from your patient. But, the success rate here is quite low. Another way is to focus on your denial management tasks. An effective denial management will boost your facility' cash flow. And by reliable, thorough and prompt payment from payers, you can focus 100% on your patients.

Unfortunately, the insurance claims are not followed up meticulously which results in the loss of revenue. Thus, you should prioritize revamping your facility's insurance claims denial management process. To make things easy, we have listed some of the denial management best practices, which will make sure a reduction in insurance claim denials.

8 Best Practices for Claims Denial Management

Claim denials directly affect your organization's revenue. And in the long run, it will upset your other administrative task. To make sure insurance claims denial cut to least, it is important to follow some of the best practices for claims denial management. We have collated a few denial management best practices for hospitals below.

1. Know the Stats
Before you dive in to tackle the claims denial, it is important to know the initial denial rate, dollar rate, and the claims rate. This will help you understand the reasons for the high denial rate in your organization. This will also open up new opportunities to improve the processes and cut the problems.

2. Keep the Process Organized
Losing track of the denied claims will lead to diminishing your healthcare organization's revenue. If the number of denials keeps on increasing, it will lead you to some serious administrative problems. Thus, an organized denial management process can help you keep track of all the claims. You can leverage HIPAA credited tools and technologies to keep track on the submitted claims.

3. Identify Denial Trends
Quantify and categorize the denials by tracking, evaluating and recording the denial trends. You can take the help from your physicians and payers. You can also leverage the expertise of your outsourcing partner. They will help reduce the claim denials and improve compliance of your medical facility. Put more emphasis on data and analytics. If you can collate and find the reasons for the claim denials, you can identify the core issue and rectify it.

4. Complete Denials Quickly
Whenever you witness a claim denial, you should follow a validated process to get that denial corrected, preferably within a week. This is possible using an established workflow which will track the claims as they enter and leave your system.

5. Create a Team
Create a team to analyze and focus on denial trends. Find out the resources that can mete out the denials. Also, leverage their expertise to put in place solutions and track and report the development. All departments must be involved and the meet regularly to discuss important issues, key reasons for denials, and how to permanently correct them.This will set up claims denial management benchmark, reduce the backlogs, and help recognize the root causes of denials.

6. Keep the Payers Informed
The resolution of the claim denials issues can also benefit the payers. A collaboration between the payers and your healthcare organization can help in addressing the issues in a more efficient manner. This will also help in achieving highest system efficiency within a short time.

7. Choose Quality over Quantity
Everybody is looking to work on as many claims as possible. However, the best way to manage the entire process with a limited number of resources and time is to follow up with the claims which are already addressed. This will help in getting more quality claims rather than several claims which do not yield anything.

8. Track the Progress
This is one of the most important practices while dealing with denial management. It helps your organization to know which areas are doing well and which needs improvement. Both the wins and losses must be documented for future analysis and improving system's efficiency. This will help you work on the improper coding and determine whether a service was covered in the claim or not.
Automating denial management processes also give you plenty of time to rework on the rejections.

Choose Us for Efficient Denial Management Services

Outsource2india has been a leading provider of denial management services in India and a series of other medical billing and coding services to global clients. We have a team of highly skilled and experienced medical billing and coding experts. They understand the importance of lost claims and how it affects your business. They will help you in automating your denial management processes.

By outsourcing denial management services to us, your claims denial rate will reduce considerably. We use some of the latest and best denial management tools and technologies to ensure delivery of the best quality services.

If you are looking for an efficient, quick, and cost-effective denial management service provider, then you have come to the right place. Get in touch with us today!