The average claim denial rate has risen considerably over the past few years. This means that there is an increase in the number of payments getting delayed or unpaid, leading to a loss in revenue and disturbing a practice’s overall revenue flow. Practices often make the mistake of blaming insurers for claim denials, but it would in fact be a better use of time to analyze the denial management strategy that is being used. There are also times when they make the mistake of not following up on denied claims, leading to an additional loss of revenue.
What is denial management?
Denial management includes identifying and correcting registration, claims billing, and medical coding flaws through trend tracking in order to develop the best solutions for reducing the number of denials. It focuses on identifying the reasons for denials and developing solutions to either reduce the risk or avoid them entirely. It helps mitigate the chances for future denials, thus ensuring that a practice receives quicker payments and a steadfast cash flow.
What are the steps involved in denial management?
Identifying the root cause of denials
The real difficulty in denial management lies in identifying the root cause of most denials. Identifying the causes, especially the recurring ones, is really important for managing denials productively. Claim denials can happen for a lot of reasons, including late claim submission, duplicate claim submission, incorrect or missing patient data, services not covered by the plan, incorrect documentation, etc. Identifying the most common cause for denials will help the practice to take steps to correct the disconnect.
Monitoring and tracking the denials
Another integral step in denial management is the monitoring and tracking of denials. It is important to have accurate records of the denied claims. This can be done according to the type, date of service, procedure codes used, patient name etc. Additionally, tracking can be done for each insurer that you file with. Maintaining the tracked date on the basis of time, source, number, and reason for denial can help with effective communication with the insurers. This aids in lowering the likelihood of future claim denials.
The next step is the actual resolution and the resubmission of claims. Managing the denials, however, is itself a multi-step process. It involves tracking all the claim denials, sorting through them to understand the different reasons for these denials and then creating a streamlined process to rectify them, if possible. The denial management process then gets implemented and utilized each time there are denials and this needs to be done in as little
a time as possible to avoid.