Insurance reimbursements in Healthcare are the important sources of revenue for any medical practice and is the "live wire for keeping the physician or hospitals in the profit zone", for this very reason, it's very critical to track and monitor the claims and investigate the reason for denials. The sources of denials are most of the times very close to us; incomplete/inaccurate information, lack prior authorization, some procedures missing, diagnoses-procedure coding errors, past filing limits submission of claims and a claim denial due to lack of medical necessity.

The modern healthcare experts suggests that the errors that triggered the denials are bound to repeat if there is no accurate follow up, thus missing every opportunity to boost revenue through legitimate appeals. Whatever the size of your practice, it is mandatory to have a claims review process not only to alert you about internal failure but also understand the trends that are causing this failure.

We accumulated some tips advised by Promantra’s denial management experts for you to identify the problems and formulate a strategy to maximize your reimbursements.

Denial Tracking:

Use healthcare IT technology to track your denials; a denial forgotten is a "lost money". Stop staring at the stacks of paper on table that appeal overwhelming, it’s in fact a huge mountain to climb without any direction. You have to be very organized in tracking the denials. A transparency tool can help the physicians and hospitals to understand why a claim is lost or delayed, this tool provides detailed information on stages where your claims are piled up or rejected and suggest improvements in claims denial processes.

Correct denials in the shortest possible time:

Prioritize bills returned by filing a deadline. Any bill returned due to incorrect submission to insurance company must be re-submitted by making necessary changes as early as possible. A strong workflow process is required to handle the rejected denials in time. This workflow must be properly communicated across the entire system to know the status of re-submissions. We at Promantra follow the timelines set by individual insurance companies while dealing with the re-submissions.

Study denials every week/Month:

Denial Management is an important part in healthcare operations. Hospitals and physicians should set aside some time every month/week to determine net loss by payer, patient type and clinical area to figure out the percentage of overall loss occurred due to incorrect denial management. This process defines the root cause of denials and help in providing the insurer with accurate information the first time.

Establish a Denial Management Team:

A team that handles only the denials will be more efficient than multiple people from different teams working on denials. We at Promantra follow this method and are very successful in handling denials of our clients. Denial management team will be responsible for all the activities starting from filing appeals to discussing issues with payer. This segmentation of workforce that solely handles the denial management is proved to be more effective than other methods.

Denial Management Outsourcing

Consider these 4 areas if you are looking for Denial Management Services

• Work flow Processes
• Experience
• Technology
• Customer Service

Which outsourcing company can bring more money from denials? What technology they use? How different are they in the service they provide? Ask these questions before finalizing any outsourcing company for Denial Management Services.

We at Promantra are successful in meeting our client’s expectations in managing their denials. Our experienced denial management services team follows a proven workflow process which overcomes all the hurdles to increase revenue of our clients that is owed to them. Contact our team today and leave the daunting task of managing your denials to us.

Also read : "Denial Management Best Practices" .

Contact us for more information or write to us at info@promantra.us

Chris Peters
AVP - Corporate Communications
chris@promantra.us
Phone: +1-732-414-3678