Step By step guide to lower Your Claim Denial Statistics 11 Apr 2022

Denial Management services

As per the Healthcare Company National Association, the best-performing medical practises have an insurance premium denial rate of only 4%. Given the often-complex maze that is required to get health claims paid by following payers, it is remarkable that these practises maintain such a low denial rate. But it is necessary to do so. What are Denial management services in Healthcare? Alternatively, you run the danger of postponing payment for your practise by weeks or even months, which will have a negative impact on your bottom line.

Claim denials are a sad consequence that many practices face on a daily basis. Why is it so important to measure and alleviate denials now, if you’re not already? First, payers have improved the sense of style of their algorithms with the help of denial management solutions, making it easier to look for patterns of denials. Second, denials are expensive. It regularly takes a significant amount of money and time to fix and/or appeal denials. Finally, ignoring dismissals today will inevitably lead to complications subsequently for the Denial Management Services Company.

What exactly is a claim denial?

Claim denial management occurs when a healthcare provider submits a claim for dispute resolution (to pay for services provided to the patient) and the payer refuses it. In contrast, a claim is turned down when it is presented to a wage earner with inaccurate or missing information or programming. While trying to navigate the world of insurance settlement forms, ICD-10 codes, and state pension requirements can be a hassle, it is not unimaginable.

  1. Diagnosis of Codes to the Largest Degree of Details

The best way to stop denials is to code the diagnosis codes with the highest level of precision possible. Clinicians who must choose ICD-9-CM diagnosis codes should choose those that provide the greatest degree of accuracy and completeness. How can we reduce denials? This entails supplying an ICD-9-CM code up to the fifth digit. According to the Health Insurance Portability and Accountability Act (HIPAA), the Centers for Medicare and Medicaid Services (CMS) requires all Medicare providers, including most private payers, to use ICD-9-CM diagnosis codes with the highest specificity.

      2. Make Use of Automated Solutions:

Human errors can be extremely inconvenient. The more human errors we can eliminate, the fewer denials we will have to deal with. Solutions that are used in reducing claim rejections and denials use specialised software to self-code accurately and without errors, raising reimbursement levels. Revenue growth can be seen if these claims are processed correctly on the first try.

     3. Staff training should be updated on a regular basis.

Inadequate or outdated staff training practises are a recipe for disaster. Although it may appear to be a minor task, regular and up-to-date staff training strengthens practise administration and thus creates a holistic and robust foundation for the denial management solutions to thrive. Staff errors are a major cause of health insurance claim denials and can be avoided by prioritizing medical coding staff training, executive seminars, and other related areas.

   4. Inadequate Financial Resources

Another impediment is a lack of financial resources and relevant technology. A practise may not be able to pay back sufficient earnings to confront and try to appeal denied allegations if it does not invest in a medical claims denial management solution that allows them to correctly submit claims in the first place. Similarly, without technology to effectively prioritize, manage, and channel claims, physician practices are unlikely to be able to streamline denial management and collect the revenue owed to them by patients and payers.

   5. The best option is to outsource:

When compared to medical billing and coding experts, it can be obvious and difficult to deal with denials with trained staff. Outsourcing denial management services to medical billing and coding companies, as well as relying on claim denials experts, is frequently the most cost-effective option. Healthcare billing businesses will provide excellent denial management by employing professionals who are dedicated to learning how to interact with insurers and understand the rationale for rejections and denials. How do I stop claims from being denied? Outsourcing ensures high customer satisfaction while also accepting responsibility.

   6. Experts in Medical Billing and Coding:

Beginning with an expert and well-trained medical billing and coding team, reducing claim rejections and denials will be brilliant. It can aid in the resolution of denial and rejection issues while also lowering the likelihood of errors occurring. If claim denials in medical billing and rejections are low, healthcare providers’ revenue will not be jeopardised and may even increase. Professional medical billing and coding services ensure and maintain the smooth operation of your revenue cycle. Addressing the root causes of claim rejections from the outset can assist healthcare organisations to reduce denials and ramp up success in proactive denial management appeals.

    7. achieving the deadline

Deadlines are a part of the system, and it is critical for healthcare billing companies to adhere to the deadlines set by insurance companies. If they are not followed, it may have an impact on the claim filing as well. Healthcare billing companies must insist on their teams filing claims within their time limits or deadlines for optimizing the claim denial management process. This ensures that forwarded claims are processed as soon as possible and that they correspond to the correct CPT and HCPCS codes, if feasible and needed.

Wrapping Line:

Finally, we hope you will find the information on denial management useful. With people under financial stress, medical organizations must work harder than ever to reduce the number of denied claims. Furthermore, you can prevent and better manage claim denials by tracking all of your claims, identifying the reasons they’re denied, recognizing each of your carrier’s claim submission deadlines and rules, and involving patients in the denial process. By implementing these suggestions, you can optimize your billing process one step further and avoid going bankrupt because your process is being compensated.

Victor Bala

Medical & coding

About the Author:

Victor has over a decade of experience in delivering revenue cycle management services to the US healthcare providers. He has a proven track record of accelerating revenue collection by streamlining the billing, coding and AR processes. His team at Velan has been delivering revenue cycle management cycle, appointment scheduling, pre-authorization and credentialing services to physicians, group practices, and hospitals. He can be reached at


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