For physicians, there’s hardly anything more infuriating than a denied insurance claim. Practitioners that are taking all adequate precautions can still find themselves stuck in such a situation. Naturally, it is time-consuming and extremely frustrating.
Revenue cycle management can greatly assist in reducing errors in the management channel, resultantly increasing the physician’s revenue. That’s what we call an arrow hitting two targets. Who wouldn’t want a healthier cash flow?
This process is typically carried out by coders and people practicing in the medical billing industry, offering medical billing services. These people possess the specialized knowledge necessary to deal with the legal aspect of the situation as well. In other words, they are well equipped with the tools you need.
There are numerous ways to ensure efficient denial management. This makes the function a lot easier for all parties involved.
A Critical and Thorough Analysis
This may seem clear but is one that is often overlooked in hindsight. There is no better advice that can be imparted. A thorough review is pivotal to this process. Ensure all aspects of the claim are reviewed.
Particularly, address concerns such as whether it was paid in full, denied, delayed, or partially paid. Moreover, if the claim is partially paid, all surrounding reasons should be specified. And specified to the dot, along with relevant documentation.
If the situation seems unclear, call the carrier. Make sure you obtain all the information involved in the procedure. You might even be able to track down an administrative error. On the other hand, it might even solicit alterations in the claims procedure the company offers. An effort can be made to streamline this.
Specialized Medical Billers and Coders
Don’t just go for anyone. Ascertain that you are opting for a medical biller who specializes in the field. This needs to be someone who has a grounded map planned out for you.
The more experienced your medical biller is, the more knowledge they have about the industry. In field experience matters more than qualification. If there surfaces any ambiguity in your case, a specialized medical biller can deal with it aptly. With hands – on experience, it will be easy to tackle a difficult situation.
Denial ratios are steadily on the rise, you need to be well prepared.
Expertise
The process of denial management can be strenuous. It can involve a lot of variables. Those variables, being various entities. Communication with these entities is key. If someone is trained in the entire supply chain of the process, the collection process becomes easier.
This entails retrieving collectibles from payers, such as Aetna, United Healthcare, Medicare, etc.
Appeals
Appeals are a crucial aspect of claim denials. There can be different types of appeals. An appeal represents explanations for the re – eligibility of a claim for payment, that may have been denied prior.
These appeals need to be prioritized. Why? Because claims can only be appealed within a certain window of time. Also, remember. Not every claim can be appealed, or even re – appealed.
The medical biller needs to be specialized. A specialized medical biller will possess the skill set necessary to fully grasp the unique situation. The medical billing services offered need to be up to par. He/she should also be well trained in the art of writing an appeal.
The construction of an appeal is what matters the most. The perfect explanation is what takes the prize. This needs to be on top of your list when considering an appeal.
Positioning Claims According to Value
The management of denied claims doesn’t have to be so stressful. It can be made cost effective. It can be made efficient. Review the denied claims according to the volume and dollar value.
This achieves a significant end. It facilitates in determining the ranking process. Namely, what claims are more important, what claims can yield the best, positive results. Again, this assists in revenue cycle management. It saves a lot of time.
Never Delay
Don’t delay. There is always a specific time frame allotted by your state. And not only your state, but also the company. Submit and resubmit your claims on time. Avoid hassle wherever possible. This helps with the entire process.
Medical billing specialists at Billing Freedom possesses extensive experience. They are highly skilled in denial management as well as other coding services.
For further information, please visit http://billingfreedom.com/
