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Denial Management- Prepare with a Strategy for Better Reimbursement

October 29, 2015

Denial Management- Prepare a strategy for better reimbursement


Due to lack of denial management strategies, a lot of money is potentially left unrecovered by medical practices. If providers focus on effective denial management, they can reduce AR days by as much as 50%, prevent revenue loss and avoid unnecessary delays in payment.

Industry Facts

High rates of insurance claim denial can lead to increased backlog of aged accounts and decreased AR
Coding errors are the reason why 5-25% of payment for physicians either gets denied or delayed
As per a survey, approximately 73% claims are denied due to lack of patient eligibility

Practices need to overcome factors that trigger denials in practices of all sizes such as lack of patient eligibility, errors in determining medical necessity and coding errors. Denial problems can be dissipated by knowing where the problem lies. Is there a problem in the medical billing and coding department or is there a problem with the payer?

Components of Effective Denial Management Process

  • To reduce denials, it is important to have a process in place so that the staff is enabled to take corrective action. Since multiple departments come under the revenue cycle of a medical practice, the denial management process needs to span each department
  • A cross-functional approach will be required, categorizing denials and assigning them to departments that can take corrective actions. For instance, a denial for missing modifier can be corrected by patient accounting, adding a modifier each time. But if this information is shared with the department responsible for charge description master, a more efficient solution can be provided
  • Practices can offer incentives to motivate staff for appealing denials successfully. For instance, if there is a reward for appealing a denial successfully, the staff will show more efficiency in taking it up
  • An electronic management program needs to be implemented in order to help physician practices and hospitals track denials and create reports that can be tracked on a monthly basis
  • Providers will have to keep a close eye on the qualitative data regarding denied claims for effective appeals

Handling Coding Challenges

With the implementation of ICD-10, medical billing and coding requirements have undergone significant changes. This has pushed the need for training of billing and coding staff so that they are better prepared for identifying problems in documentation and coding with highest level of accuracy.

MBC Helping Practices Reduce Denials and Maximize Returns

With payers becoming stringent in their review and denial of claims, many practices are combating revenue challenges through outsourcing. As the leading provider of billing and RCM solutions, MBC serve more than 42 medical specialties across all 50 states in the US, helping providers identify trends and root causes of denials, increasing recovery of payments, automating workflow for better efficiency and helping practices improve departmental productivity.

MBC has a team of certified, experienced coders who perform effective denial management. The company also has a team of AR experts who work 24/7 to bring in uncollected payments.


Category : Revenue Cycle Management