Claim Denial Management Solutions to Improve Your Bottom Line

by | January 24, 2022 | 2:49 pm
Claim Denial Management Solutions to Improve Your Bottom Line

Claim denial can be frustrating. When it happens, businesses need to rework the application, often losing both time and money. Denied claims also negatively impact business cash flow. The higher the incidence of denied claims, the worse the impact on cash flow. Every denied claim is a payment that is deferred or delayed until the claim is resubmitted.

Resubmitting a claim is time-consuming. Furthermore, the amount of time lapsed in claim resubmission affects the amount of reimbursement received.

Claim denial management is important because:

  • Approved claims
  • Delayed claims can cause a loss of revenue.
  • Diligent tracking of patient records, invoices, and payments is necessary to ensure claims are processed on time.
  • Denied claims may indicate other problems in business operations, particularly in accounting and financial management.

Sources reveal some of the reasons for claim denials:

  • About 18 percent were denied because the claim was for an excluded service.
  • About 9 percent were denied due to prior authorization or lack of referral.
  • Less than 1 percent were denied due to reasons based on medical necessity.
  • Other reasons include plan-reported denials.

Ensuring better claim denial management

Businesses need to ensure efficient claim denial management and must work to minimize claim denials because of the following factors:

  • Denied claims can cause a loss in income and revenue, at times becoming a threat to business sustainability.
  • Claim resubmission may be written off as bad debt if it gets significantly delayed, eventually negatively impacting finances.
  • Sustained bad debt eventually negatively affects business cash flow, affecting the financial health of the business, adversely impacting opportunities for investment, loan assistance, and other opportunities for business growth.

Resolving claim denial management is central to ensuring better profitability for the business, and solutions can include the following approaches:

Leveraging medical billing assistance

Medical billing can be a complex process. This process includes claim management. One of the key ingredients for effective medical billing assistance is trained staff. However, hiring trained resources can be an expensive proposition for small to mid-sized businesses. These businesses may not have the necessary budget. In-house resources can be time-consuming and expensive; since high turnover due to attrition can hurt the business and lead to financial losses.

Action item: Professional assistance in terms of a partnership for medical billing helps shift the administrative burden of hiring and training resources from in-house to outsourcing experts. This process helps free in-house business resources, enabling them to focus on better record-keeping and registration details, including insurance checks and prior authorizations.

Professional assistance with Revenue Cycle Management (RCM)

Effectively managing the revenue cycle is at the heart of efficient medical billing. Professional assistance for revenue cycle management can streamline the business accounting and bookkeeping. In turn, this creates better financial records for RCM.

Action item: Professional assistance comes in the form of trained resources and ready infrastructure. For businesses just starting, or poised for growth, partnering with experts frees time, resources, and money, so that business professionals can focus on business opportunities.  Outsourcing ensures better optimization of in-house resources without affecting existing business or revenue.

Ensuring better claim management

Claim management for medical equipment businesses comprises multiple elements. This process includes error-free information and accurate patient data, timely submission of the application, and compliance with insurance provider rules for submission. Claim denial management can consist of significant reviewing of documents. This step may include checking for covered and non-covered services, patient plans, insurance beneficiaries, modification, or changes in the life status of covered individuals. This process may change the outcome of the insurance. In-house resources must be equipped with knowledge and training to handle the task.

Action item: Professionals possess experience handling insurance claims and understanding the process and requirements. Medical billing outsourcing assistance is ideal for handling the high-volume documentation associated with large-sized medical equipment businesses. They are also ideal for startups and small to medium-sized businesses because they bring ready infrastructure and staffing resources. Thus, they save on time and investment that would otherwise be spent in setting up in-house systems.

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