{"id":1524,"date":"2012-10-26T06:41:34","date_gmt":"2012-10-26T06:41:34","guid":{"rendered":"http:\/\/www.medicalbillersandcodersblog.com\/?p=1524"},"modified":"2025-05-19T13:24:43","modified_gmt":"2025-05-19T13:24:43","slug":"denial-management-integral-to-physicians-conquering-reimbursement-challenges-while-medical-billing","status":"publish","type":"post","link":"https:\/\/www.medicalbillersandcoders.com\/blog\/denial-management-integral-to-physicians-conquering-reimbursement-challenges-while-medical-billing\/","title":{"rendered":"Denial Management \u2013 Integral to Physicians\u2019 Conquering Reimbursement Challenges While Medical Billing"},"content":{"rendered":"<p style=\"text-align: justify;\">Denials are responsible for major erosion of practice revenues, and, despite the best efforts, denials continue to assume monstrous proportions.<\/p>\n<p style=\"text-align: justify;\"><strong>The situation has grown so alarming that:<\/strong><\/p>\n<ul style=\"text-align: justify;\">\n<li>Medical practices fail to collect 25% of the money they are owed<\/li>\n<li>$125 billion is left in the bag as unpaid claims<\/li>\n<li>Only 70% of claims are paid the first time they are submitted<\/li>\n<li>Of those denied claims, 60% are never resubmitted to payers<\/li>\n<li>Medical practices never pursue 18% of claims at all<\/li>\n<\/ul>\n<p style=\"text-align: justify;\">While payers (whether Medicare, Medicaid or private health insurance companies) are justified in denying claims with inherent errors, it is physicians who are responsible for not pursuing with resubmission and intensified efforts. This is where <a href=\"https:\/\/www.medicalbillersandcoders.com\/revenue-management-services.aspx?DivId=denial-management-appeals\">Denial Management<\/a> becomes significant.<\/p>\n<p style=\"text-align: justify;\"><span style=\"text-decoration: underline;\">Denial Management<\/span> comprises thorough analysis of denials and ways to convert denials into reimbursements. The crucial part of an efficient denial management practice is re-appealing with substantial proof.But the actual process of your denial management starts with <span style=\"text-decoration: underline;\">knowing the reasons for denials.<\/span><\/p>\n<p style=\"text-align: justify;\"><strong>Over a period of time, it has been seen that payers base their rejections on the following:<\/strong><\/p>\n<ul>\n<li>Registration inaccuracies, wherein either patient\u2019s insurance is not verified or a wrong payer is mentioned or it is difficult decipher patient\u2019s identity<\/li>\n<li>Charge Entry with unacceptable procedure or diagnosis codes<\/li>\n<li>Lack of referrals &amp; pre-authorizations<\/li>\n<li>Inadequate information about patient<\/li>\n<li>Claims with code duplication for the same procedure<\/li>\n<li>Lack of substantial proof for medical necessity of a procedure<\/li>\n<li>Inaccuracies in clinical documentation<\/li>\n<li>Bundling non-allowable items or applying modifiers where they are not permissible<\/li>\n<li>Lack of credentialing<\/li>\n<\/ul>\n<p style=\"text-align: justify;\">Once you have known the root causes for denials, it should lead you to <span style=\"text-decoration: underline;\">analyze the extent of denials<\/span> as against the actual submission. Practice Management System (PMS) makes it easy for you to track down denied claims. The advantage of having a PMS in your practice is that it reflects the exact payment posting against each of the submitted claims making it easy to identify the under realized or denied claims.<\/p>\n<p style=\"text-align: justify;\">Having known the reason and the extent of denial, it is now time to put your denial management skills into practice. While <span style=\"text-decoration: underline;\">coding revision and modification <\/span>set the things in motion, it is the relationship with the payers and adjudicating agencies that would eventually tilt the balance in your favor.<\/p>\n<p style=\"text-align: justify;\">But it has been found out the physicians are either reluctant or do not have time to focus on these denial management skills amidst their busy clinical schedule. The fact that their internal staff too lacks these skills has not helped their cause. Therefore, medical billing consultancies that offer to integrate denial management processes into your medical billing practices should offer the much needed relief.<\/p>\n<p style=\"text-align: justify;\"><strong>Medical Billers and Coders<\/strong> \u2013 being a proven medical billing consortium offering quality and result-driven medical billing services \u2013 across <span style=\"text-decoration: underline;\">all 50 states<\/span> for <span style=\"text-decoration: underline;\">over a decade<\/span> with experience in handling a varied payer mix &#8211; are known for elevating practice revenues through integrated denial management.<\/p>\n<p style=\"text-align: justify;\"><strong>To substantiate our denial analysis, we follow these steps carefully:<\/strong><\/p>\n<ul>\n<li style=\"text-align: left;\">Figure out specific causes for the accumulation of the denied receivables. Such denial analysis provides us the characteristics of the denials, and an opportunity to get them resolved comprehensively.<\/li>\n<li style=\"text-align: left;\">Analyze the financial impact of the denials; our team of expert medical billing professionals is adept at identifying the general pattern and stake of the denials to evaluate its impact on financial returns.<\/li>\n<li style=\"text-align: left;\">Provide feedback to improve the efficiency through root-cause analysis and financial impact analysis of denials.<\/li>\n<\/ul>\n<p style=\"text-align: justify;\">MBC\u2019s unique integrated approach has helped physicians of <span style=\"text-decoration: underline;\">varying sizes &amp; specialties<\/span> by interpreting the reasons for denials, increasing resubmission and realization through instant denial analysis and management process.<\/p>\n<p style=\"text-align: justify;\">For more information visit: <a href=\"http:\/\/www.medicalbillersandcoders.com\">Medical Billing Companies<\/a><\/p>\n","protected":false},"excerpt":{"rendered":"<p>Denials are responsible for major erosion of practice revenues, and, despite the best efforts, denials continue to assume monstrous proportions. The situation has grown so alarming that: Medical practices fail to collect 25% of the money they are owed $125 billion is left in the bag as unpaid claims Only 70% of claims are paid [&hellip;]<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[17],"tags":[18,15,9,253,346],"class_list":["post-1524","post","type-post","status-publish","format-standard","hentry","category-claims-denials","tag-denial-management-2","tag-medical-billing","tag-medical-billing-companies","tag-medical-billing-consultants","tag-practice-management-system"],"yoast_head":"<!-- This site is optimized with the Yoast SEO Premium plugin v27.8 (Yoast SEO v27.8) - https:\/\/yoast.com\/product\/yoast-seo-premium-wordpress\/ -->\n<title>Denial Management \u2013 Integral to Physicians\u2019 Conquering Reimbursement Challenges While Medical Billing - Medical Billing and RCM Blogs<\/title>\n<meta name=\"description\" content=\"Learn about Denial Management \u2013 Integral to Physicians\u2019 Conquering Reimbursement Challenges While Medical Billing in our latest blog post. Medical Billing and RCM Blogs\" \/>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/www.medicalbillersandcoders.com\/blog\/denial-management-integral-to-physicians-conquering-reimbursement-challenges-while-medical-billing\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Denial Management \u2013 Integral to Physicians\u2019 Conquering Reimbursement Challenges While Medical Billing\" \/>\n<meta property=\"og:description\" content=\"Learn about Denial Management \u2013 Integral to Physicians\u2019 Conquering Reimbursement Challenges While Medical Billing in our latest blog post. 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