DENIAL MANAGEMENT

Health claims One of the biggest issues that doctors, physicians, and other healthcare professionals deal with is denial. A typical American hospital can easily experience an initial rejection rate of 7–10% for its claims, even though the standard best practise recommendation is to keep the denial rate at 4% or below. Such denial rates frequently lead to operational losses for many organisations, and these losses cannot be made up.

The goal of the SMBS denial management service is to screen your data and identify the underlying cause of every denial. Our team is able to track, analyse, and report denials, locate unpublished rules, and offer potential corrective measures for particular denied claims. At the same time, we can assist you in identifying and putting into practise process improvement techniques to get rid of recurrent denials and improve

SERVICES WE OFFER

Medical institutions must comprehend, quantify, and address the underlying causes of current claim denials in order to establish a reliable denial management process and prepare for the industry’s predicted revenue decline over the next few years. One of the main services we offer is

Determining The Denials Reasons

Finding the main justification for the claim’s denial is the first step in our process. The payer will provide the status code and the justification for the remittance when the adjudicated claim is returned. A thorough review of your billing practises and management may be necessary to uncover the obvious and covert causes of persistent denial. Our team at SMBS is fully aware of where to look for issues and how to resolve them in order to minimise denials and practise efficient claims management.

Categorize The Claims Denials

The next step after determining the quantity and causes of rejections is to categorise the rejections so that they can be tracked and sent to the proper department for correction. It will be possible to spot opportunities to change workflows, processes, or employees’, doctors’, and clinicians’ knowledge by categorising and examining rejections by category.

Prevention And Monitoring

To stop recurring revenue leakage, denial management is an ongoing process that needs to be constantly monitored and assessed. Scottsdale Medical Billing Solutions’ qualified staff can assist.

Create a multidisciplinary team that can review trends and analyse rejection data together, choose which categories need to be addressed first, and talk about solutions.

Plan frequent gatherings with multidisciplinary teams to concentrate on particular denial categories.

To make sure these internal control measures are effective at handling and preventing rejections, it is necessary to continuously monitor their performance.

Implementing Tracking Mechanism

We create a reporting mechanism that makes it simple to ascertain the following details after classifying the causes of claim denials.

Top categories of denials affecting the organisation

a negative impact on the organization’s revenue due to the amount of denied claims

The top department or service area impacted by the claim denial

OUR STRATEGIES TO MINIMIZE DENIALS

Every business must take some actions to streamline the medical billing process and lower the number of denied claims. The following tactics are employed by SMBS to lower the quantity of rejections:

Patients Eligibility

Our staff members are qualified to gather details regarding each patient’s eligibility for benefits and health insurance coverage. Even before a patient is admitted to the hospital, our practise management system can confirm their eligibility and benefits.

Prior Authorization

Your scheduler is pre-authorized for each service that needs it thanks to a procedure we follow. To ensure that your staff is aware of when to obtain the authorization before providing the services, we will look into the pre-authorization requirements for in-office procedures that are typically ordered during patient visits.

Coding Errors

The increase in coding errors brought on by the switch to ICD-10 could result in more claim denials. The services that your practise typically offers will be identified, and we will then seek professional advice on how to code these services. We will take proactive steps to reduce coding errors. Before submitting each claim, SMBS’s coding specialists will examine and confirm the code.

Medical Necessity

Because the diagnostic code provided does not support the demand for the service offered, the insurance company may reject the claim. We employ software with editable fees to decide the coverage in order to prevent this. Additionally, we will gather information on medical necessity policies from all of your insurance providers.

WHY TO CHOOSE SMBS FOR DENIAL MANAGEMENT SERVICES

Long-term efficiency can be increased, and income loss can be significantly reduced, by comprehending the various justifications for denials. You can analyse the remittance proposal effectively with the aid of the SMBS denial management process in the medical billing application, revealing the chance to successfully prevent rejection. You can trust us.

Control all payers’ claim rejections
Complete adherence to HIPAA’s technical security and privacy requirements.
To gauge the results of process improvements, provide key trend reports.
Offer high-quality services with a quick turnaround at a reasonable cost.
To manage all facets of denials and resubmission, give all users access to an on-demand view.
SMBS