Healthcare Denial Management Services:
Unlocking Your Revenue Potential
In the complex landscape of healthcare billing, the effective management of denied claims is a critical component of financial success for medical practices and healthcare providers. At ProMantra, we understand that the key to successful denial management is not just addressing the denials as they occur but also systematically gathering, analyzing, and leveraging data to prevent denials from happening in the first place. Think of it as fixing the pipe so that you no longer need to pump water from the basement.
The Power of Data in Denial Management
Achieving powerful results from denial management requires one thing above all else: data. We believe that data is the key to identifying the root causes of denials and implementing effective solutions. Our denial management services are founded on the principle that comprehensive data is the foundation of success. Our approach includes
Process Reports and Data Analysis
We systematically process and analyze all claims that are denied by your payers. This level of data granularity empowers our specialists to pinpoint the exact issues leading to the denials. Whether the problems lie within the claims themselves or with the payers, we leave no stone unturned.
Fixing the Issues
Armed with this detailed data, Coding Denial Management Services, we work diligently to fix the underlying issues that lead to claim denials. We’re not simply addressing the symptoms; we’re curing the ailment. This proactive approach means we can put an end to the torrent of unpaid claims flooding into your medical billing process.
Revenue Enhancement
The result of our efforts is clear – revenues for your practice can increase significantly, often by 10 to 20 percent. Denial management becomes a revenue enhancement strategy, not just a claims resolution process.
Addressing Common Denial Management Challenges
We’ve learned from our extensive experience that three critical elements are typically missing from a practice or medical provider’s denial management process: data, effective filtering/sorting methodologies, and systematic feedback for error correction.
Data Tracking
Most practices and practice management systems do not properly track denials. Even if the capability is present, it often remains underutilized. At ProMantra, we track every denied medical claim and report this data by payer, by Current Procedural Terminology (CPT) code, by physician, and by diagnosis. This comprehensive approach allows for the rapid identification of trends, an essential component of effective denial management.
Filtering and Sorting
The practice management systems that do track denials often overwhelm the practice with data that is difficult to utilize for high-level denial management. We filter and sort data to present it in a manner that enables fast identification of trends and patterns.
Systematic Feedback
Even if data is captured and can be properly utilized, most practices do not have a systematic way to get the information back into the billing process in a manner that prevents similar denials from occurring in the future. At ProMantra, our analysis and data utilization are geared towards precisely this outcome. We identify trends and patterns to inform claim rules and edits that dramatically drive up first-pass claim acceptance rates.
Our Denial Management Solution: A Three-Pronged Approach
ProMantra’s Denial Management Solution is built upon three key pillars
Prevention
Prevention is the first line of defense in denial management. Our experts focus on taking preventive actions upstream in the patient encounter to stop denials from occurring in the first place. This can be introduced at various points in the patient encounter, including pre-admit/pre-registration, scheduling, admit/registration, and billing. By tracking trends, we can periodically inform our clients about improvements and process changes that can be implemented across functions.
Analysis
The process of analyzing and aggregating similar denials is strategic in denial management. At ProMantra, we understand that effective analysis and segregation are prerequisites for the follow-up process. We consider this a fundamental step in our claims denial management services.
Tracking and Trend Management
In addition to monitoring denial trends from payers, we actively track payment patterns. When we identify deviations from the normal trend, we set up mechanisms to alert our clients. This is invaluable in understanding the causes of claim denials, enhancing long-term efficiency, and drastically reducing lost revenue.
Key Functions of Our Denial Management Services
Maximizing Cash Flow
Our reporting identifies denial causes with the most significant financial impact, accelerating cash flow for your practice.
Root Cause Identification
By collecting and interpreting patterns, we quantify denial causes and their financial impact, enabling you to address issues at their core.
Workflow Prioritization
We collect information on denial appeals, including their status, escalation, correspondence with payers, and the disposition of the appeals. This not only increases recovery amounts but also supports accurate workflow priorities and scheduling for follow-up.
Accurate Statistics for Management/Clients
We provide management analysis reports and other information that can help prevent future denials. This includes tracking, prioritizing, and appealing denials, generating appeal letters based on federal and state statutes and case citations favoring the medical provider’s appeal, and avoiding out-of-timely filing.
Analyzing Effectiveness
We analyze the effectiveness of the resolutions we implement and identify business process improvements to avoid future denials.
ProMantra’s Denial Management Services are designed to empower your practice to tackle denials proactively, minimize financial losses, and optimize your revenue cycle. By turning data into actionable insights and implementing preventive measures, we can help you unlock your revenue potential. Contact us today to learn how we can enhance your denial management processes and improve your practice’s financial health.