Introduction

Denial management in medical billing is about resolving issues between healthcare and insurance providers. It ensures that healthcare providers receive timely reimbursement against the provided care facility. This is crucial because when payments are denied, it leads to problems like mismanagement at the administrative level and resource wastage. This article focuses explicitly on all good denial management practices that help optimize revenue. To make the denial management process smoother, there are strategies that healthcare providers can follow. All these strategies will be discussed in this article.

Denial Management in Healthcare

Denial management in healthcare is a practice of fixing and preventing problems with insurance payments after providing the healthcare facility. Denial management is all about making sure that doctors and hospitals get paid correctly and timely. Denial management is a matter of great concern because it causes problems like late payments, time wastage, wastage of resources, and uncollectable revenue. As per statistic, these problems have increased by 20% in the past five year in the whole industry.

Different Types of Denials

Eligibility Denials: Such denials occur when a patient’s information is not appropriately collected during his registration. They can also result from changes in coverage during a patient’s stay at the hospital, especially when it goes beyond a prescribed period. To avoid these troubles, it is imperative to get patient information early and re-evaluate the eligibility checks before billing.

Invalid Data-Related Denials: These denials happen when submitted data is incomplete or incorrect. They can usually be fixed by adjusting data in the billing software.

Authorization-Related Denials: These are usually hard denials that are difficult to fix. They occur when a required authorization isn’t obtained before obtaining health service.

Non-Covered Service Denials: These are also hard denials. They occur when the patient’s plan doesn’t cover the acquired care service. Such denials also occur when a patient’s stay or availed facility exceeds from the allowed limit. Recovering money from these claims is hard, however, documentation and appeals might help to reclaim bills.

Inadequate Documentation Denials: These are usually soft denials that are easy to fix. Such denials occur as a result from missing or not receiving requested documentation at the end of the patient. Such denials can be fixed by resubmitting the complete information or providing extra details to insurance companies. Read More...