The efficiency of a revenue cycle management systems plays a crucial role in the success of medical practice. It means that denial management services help to reduce the chances of denial and rejections. It helps in better cash flow and improving the overall efficiency of billing operations.
The health care companies, while sending bills to the insurance organizations, check for errors. Despite all measures, denial and rejections happen, which lead to heavy loss for the provider and the company. At times, denials and rejections hurt reimbursement, as well. The claim denials and rejections are misunderstood in the medical billing industry, which leads to costly errors and a heavy impact n the entire system.
Experts suggest hiring specially designed healthcare denial management services that would help to get through the complex maze of medical claims paid by third-party payers. It is quite interesting to know that these services will help in keeping the denial rate low. These services would help in avoiding delay in the payment by weeks or months.
Most patients use denials and rejections as a synonym for the other and commonly misunderstood in the medical billing company. Hence, it is very crucial to understand the difference between the two.
The accounts receivable management system of the insurance companies receives the submitted claims and processes it; but marks them as denied, mainly because of errors or lack of details related to pre-authorization, identified while processing. Studies show that denials could be due to loss of information, non-covered services, inaccurate details of patients and services.
In this case, one cannot resubmit the claim, as one should do enough research to understand the reason for denial. Lack of knowledge and research would mean repeated rejection, along with loss of time and money. The healthcare billing companies would make efforts to correct the error and appeal again’ which would surely consume time. Everyone is aware that the insurance companies have a set deadline for a correct claim. It would surely increase the chances of an unpaid claim, which could turn into a liability soon.
If the claim is not as per the billing guidelines, the insurance company puts it into the rejection category. It could be due to coding error, misunderstood procedure, improper codes or termed patient policy. The companies cannot process these claims, as they would not have received or an entry in the computer system.
Healthcare billing companies would opt for A/R Follow-up services, which could help detect the reasons for rejections, which could be in the form of patient’s insurance ID number, address details etc. Hence, it is crucial to maintain proper medical documentation, which could be helpful during the trouble with the claim. The rejected claim can be filed again, within the restricted time.
Medical companies can follow a few tips to increase the chances of a successful claim. The crucial yet useful tips are:
- Use of automated solutions would help in reducing human errors. It would help in processing in the first attempt, aiding revenue growth.
- Check patient records for inaccurate information, errors in pre-authorization. It would help to keep the system updated and in educating staff.
- Learning from previous rejections could be the best method to move forward with new claims.
- Meeting deadline is critical for a successful claim.
- Keeping one updated with the latest technologies and changes could help in making a correct claim.
Many experts suggest hiring an outsourcing company; for handling the denials in the best possible way. It helps in making it a cost-effective option.