Dealing with Denials

shutterstock_180212732Denials equate to lost money. Not just sometimes, every time. In fact it costs providers an average of $14.92 to process, resolve and resubmit each denied claim. Even if you resolve them quickly, reimbursement denials inevitably slow your cash flow, create re-work and consume valuable staff resources that could and should be focused somewhere else.

Efficiency is the key to reducing insurance denials and dealing with the ones that do occur. Here’s how to improve your efforts in this regard:

Monitor Pull a report for all suspended claims, or pick several at random and call the insurance company to ensure that they have been received.

Use denial codes Never just automatically write claims off at the first rejection. The employee keying payments should post the type of denial (non-covered service, etc.), mark it on the explanation of benefits (EOB) and give it to someone to re-work.

Understand the appeal process If a claim is denied again after it has been re-worked and corrected, then consider appealing it. Work from a customizable appeals letter template.

Know the deadlines Don’t miss important filing deadlines as you re-work claims. Do careful tracking and assign staff accountability as appropriate.

Keep track of self-suspended claims Don’t forget about claims that the practice has suspended because of inaccurate or missing information or other details. Assign staff accountability to assure self-suspended claims are worked, resolved and submitted as quickly as possible.

Stop playing the blame game Identify problems and find ways to fix them. When the same mistakes occur over and over again, it is often due to a faulty a process or procedure, insufficient monitoring or a lack of training.

The importance of denials management can’t be stressed enough, and following these simple steps will help you minimize their impact to your revenue cycle.

While there are numerous causes of denials, ICD-10 is certainly chief among them. Learn more about how to prevent the negative impact of ICD-10-related denials will have on your revenue cycle.

Download our recent article, 3 Steps for Preventing Denials Associated with ICD-10, published recently in HFMA’s Revenue Cycle Strategist.

About Kent Smith

Kent Smith

Kent leads MediRevv’s new business sales initiatives and marketing and account management programs. He has built, from the ground up, a cohesive team of healthcare sales and marketing professionals who understand the critical aspects of any engagement: exceeding the expectations of and creating value for our clients; building enduring, mutually beneficial partnerships; and maintaining transparency and a high level of trust in our execution.

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