Top 5 Lucrative Ways of Better Denial Management for Physicians

April 06, 2015

The biggest of challenges faced by physicians today are not solely related with patient care. It also has to do with business side of health care, especially concerning medical billing and administering better denial management services.

In a research by a Washington DC-based global health care research firm, it has been established that denials cost as much as 3% of practitioner’s net revenue. Indeed, nothing is more frustrating for the practitioner than a claim getting rejected in part or full. Per se, there is an urgent need to enhance the practice’s financial health. Here are some lucrative means to the end, adopting one or more of which at the provider’s office is bound to reap rich dividends: -

  1. The front desk at the provider’s office should perform insurance eligibility verification prior to the patient’s visit during the time off the practice schedule. This practice can save the provider’s office with at least 1% of their annual income. Identifying insurance issues before time would allow the office to improve upon the issues and know the A/R of patients. Thus, the provider’s office would know exactly how much is the medical policy coverage, how much are the copays and what are the deductible shares that must be collected from the patient at the time of next appointment.

  2. It is estimated that a good Denials Software reduces denials up to 6% by identifying reasons of the denials and their occurrences. However, software alone cannot resolve the challenges in the appeal, its submission or follow-up with the payer. By combining technology with dedicated denial staff offered by denial management services, physicians can reduce denials up to 18% Industry Benchmark.
  3. The patient follow-up calling should be made an integrated part of front office processes. The provider’s office should notify any insurance issues and pending A/R balances to the corresponding patients from time to time. This helps the patients understand insurance and their financial obligations better. Not to mention, this integration organically contributes to cleaner medical billing, and in turn increase in cash flow with faster collection and early resolution.
  4. The contracts and fee schedules should be matched with payments received from the Insurance Company. This would ensure full payment and identification of what needs to be appealed, resubmitted or missing. If claims are not paid within a specified time period, the front desk of the provider’s office must follow them up with the insurance carrier. Further, based upon the information gathered, necessary action should be taken on the unpaid claims to correct and resubmit the claims. This may include re-billing, re-coding, or sending appeal letters.
  5. At last, but not the least, HIPAA compliant web-based application should be installed for the front office management of the provider’s office. It would enable real-time access to patient’s information and centralization of all communication without excel sheets or emailing. This eventually would help in smoother and cleaner medical billing.

As per MGMA, a practice is not doing well if its denial rate is over 4%. The average claim denial costs $25 to $30 each, which is quite a lot of money trickling down the drain every year. So, either adopting the above measures or hiring professional denial management services provider, becomes all the more pivotal.

Medicalbillersandcoders.com with its effective and efficient denial management solutions prevents majority of medical claim denials and maximize revenue. Their denial management services safeguard the provider’s office from any legal problems caused by carelessness of physician’s office.


Category : Accounts Receivables / Claims Denials