“Enriching Healthcare service providers around the nation
for over 20 years.”
Denial Management
US Medical Billing Services' denials management decreases your AR days and increases your collections. Our specialty specific guidelines help our AR experts to resolve denials efficiently. We look at no-pays and low-pays and get to the root of the problem. Our experts not only fix a denied claim but proactively make changes to our procedures to avoid future denials. Our AR team works very closely with our coders to fix and eliminate coding related denials.
What is meant by ‘denial’ in medical billing?
The formal definition of denial in medical billing is “the refusal of an insurance company or carrier to honor a request by an individual (or his or her provider) to pay for healthcare services obtained from a healthcare professional.”
Medical claim denials by a payor are a headache for any provider. Healthcare industry statistics show that there is a 5-10% denial in the case of practices. Reworking the claim is also going to cost money for practices.
Our team of trained billers has expertise in clinical denial management and will keep denials to the minimum. The medical billing denial management process includes analysis of root causes of claim denials, rectifying errors, resubmitting the claims and follow-up.
What are the primary reasons for denials by payors?
Payors deny claims for many reasons. The significant reasons are of the following types
- Incomplete information
Demographic and coding errors come under this category. All required fields should be entered and coding done correctly.
- Duplicate claim for the same service
Sometimes claims may be resubmitted for a single encounter on the same date. The provider, beneficiary and service would be the same. Hence the rejection of the duplicate claim by the payor.
- Service not covered by payor
The insurance plan does not cover the medical service mentioned in the claim. When eligibility verification is not done thoroughly, this error can happen.
- Time barred claims
Most payors stipulate that claims should be filed within a certain number of days of visit/service. This time limit includes the days taken for rework of rejections. Hence monitoring the claims process with payor as part of the revenue cycle denial management is crucial.
We are one of the top denial management companies. Our billers are regularly trained in the medical billing denial management process so that the errors pointed above rarely occur. The denial management process is designed for the resubmission process to be efficient and smooth.
Denials management process at US Medical Billing Services
Our denial management services follow a three-step process
- Tracking
We review the explanation of benefits received from all payors. We track all partial payments and non-payments. We keep track of denials, provider-wise, procedure-wise and payor-wise. Our investment in technology helps us in keeping track of many factors. Technology and our excellent human resources result in superior denial management solutions for clients.
- Categorizing
We categorize denials by type and assign a denial code to it. Through our categorization, we can determine the common reasons for denials. This method serves as a great tool in claims denial management.
- Analysis
We analyze the types of denials reason-wise and list them with claim value. Our expert team conducts a root cause analysis for each category and we set about rectifying the errors immediately. We handle the denial management in RCM with speed and accuracy.
Our standard operating procedures at every step of the revenue cycle are modified/updated to avoid and eliminate these denials in the future. This ability to be flexible in order to evolve is the key to our success in medical claims denial management.
In our medical billing denial management process, (i) rectified claims are resubmitted at the earliest, and (ii) we file appeals wherever required with supporting clinical documentation. We are always in touch with payors to enable us to do everything needed to get the claim reimbursed.
What are the benefits of partnering with US Medical Billing Services?
Denials management in medical billing requires time and resources to be successfully handled. It is not something that all practices have, especially with the continually changing industry regulations and payor-specific rules.
US Medical Billing Services has long experience in denial management in healthcare industry and our team of expert billers will systematically handle practice and hospital denial management. We will drastically reduce your pending claims, thus improving your practice revenue.
Our Denials Management helps you to
- Increase collections and improve cash flow
- Reduce Accounts Receivable days
- Reduce rejections and denials
- Improve the operational efficiency of the entire revenue cycle
SERVICES
Our Denial Management Services
We manage to have a slight lead over our contemporaries by empowering our clients with the following services.
Appeal
We appeal when a payor rejects a claim. We prepare the requisite papers and additional documents and submit the appeal.
Follow-up
Our team will speak to patients to obtain missing details and documents. We follow-up with payors also to track claims.
Credit Balance Audit
Our team does a periodical audit of patient accounts to check for unidentified and duplicate payments. These will be adjusted or refunded.
BENEFITS
The Benefits Of Our Medical Billing Services
Superior Quality of Service
Lesser Turnaround Time
Cost Effective Pricing
Minimum Rejections
Dedicated Account Management
Effective Processes
Use Of Latest Technology
Uninterrupted Cash Flow
Why Choose us?
We ensure that the billing process is smooth, efficient and result-oriented for our clients. We are invested in the success of our clients. Our clientele includes several top healthcare providers in the USA. Reach out to us and become part of the family of happy and satisfied clients.
