Denial Management is a critical element for a successful RCM. Denial of medical claims has been the biggest concern for physicians, doctors & other healthcare professionals. Recurring denials or increase in denials lead to operational losses which are difficult and sometimes impossible to recover.
The top reasons or Denial management are as follows:
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Missing information, such as absent or incorrect patient demographic data and technical errors
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Wrong or Missed ICD-10 diagnoses
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Wrong or Missed CPT-4 modifiers
Our Denial Management Services
Identifying the Most Common Reasons for Denial
The first thing we do is figure out why the claim was denied in the first place. The payer will return a status code as well as the reason for the remittance when adjudicated claims are returned unpaid. Understanding the common and hidden reasons for frequent denials may necessitate a thorough review of your billing procedures and management. After this, our team will know exactly where to investigate and address the problem in order to reduce denials and improve claim handling.A/R analytics
Sorting and Categorizing the Denials
After determining the number and reasons for denials, the next step is to categorise them so that they can be tracked and forwarded to the relevant department for resolution. Sorting and analysing denials by category will help identify areas where processes, workflows, or employee, physician, and clinician knowledge can be improved.
Creating a Tracking Mechanism
We create a tracking/reporting method after categorising the reasons for denial, which allows us to readily determine the following information:
The most common types of denials that have an influence on the organization:
- Top payers with the most impact on the organisation in terms of denied claims dollars
- Denied claims have an influence on top departments and service areas.
Monitoring and Preventative Action
Denial management is a continuous process that must be checked and evaluated on a regular basis to avoid income leakage. Viaante’s denial management team assists in –
- Create a multidisciplinary team that can evaluate denial data, review trends as a group, decide which categories to target first, and talk about how to resolve them.
- To focus on a certain denial category, schedule regular meetings with the interdisciplinary team.
- Continuously assess the adequacy of these internal controls in terms of their ability to manage and prevent denials.
INSIGHTS
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Million+
Healthcare transactions annually
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Annual Provider Credentialing
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Provider Specialties
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Million+
AR collections
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Charge Entries
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Payment Postings
Benefits of partnering with Viaante:
- Manage claims denials from all payers
- Drive initial denial rates below the industry best practice of 4%
- Provide key trending reports to measure the impact of process improvements
- Deliver full compliance with HIPAA technical security and privacy provisions
- Provide quality services at cost-effective rates within a quick turnaround time
Because we don’t just believe in quality deliverables but also in delightful business operations and that’s what makes us different.
We have years of domain expertise across the national boundaries. The clients trust us for what we have, what we deliver and especially for what we have achieved will achieve together.
At Viaante, it’s not about the cost but the value. We have been building this value by consistently serving our clients with quality deliverables and that’s what Viaante will always do.
TESTIMONIALS
PLATFORM EXPERTISE
WHY VIAANTE
Because we don’t just believe in quality deliverables but also in delightful business operations and that’s what makes us different.
We have years of domain expertise across the national boundaries. The clients trust us for what we have, what we deliver and especially for what we have achieved will achieve together.
At Viaante, it’s not about the cost but the value. We have been building this value by consistently serving our clients with quality deliverables and that’s what Viaante will always do.