1. Identify Underlying Reasons for Claims Denial
When hospitals become aware of the reasons why a provider denied a patient's claim, it can help them prevent similar occurrences in the future as well as improve revenue generation. Not everyone in need of hospitalization is aware of ins and outs of the claims denial system. Hence, it is up to the hospital to educate patients on how their claims will be processed. And for that, Systems Hospital Surveys and Hospital Consumer Assessment of Healthcare Providers are bodies responsible for providing better satisfaction to the patients.
6 Best Practices for Hospital Denial Management
What will you do if your medical claim has been denied? Does it mean the end of the road for getting reimbursed? How do claims get settled after appealing? These are some of the questions asked by those who apply for claims. We have the answers for you. Before that, let's look at what hospital denial management is, as well as claims denial management challenges that pervade the system.
Imagine you are hospitalized for the illness, and after treatment, you are filing claims hoping all is well and your valuable money will be reimbursed because the payer promised treatment coverage with a low rate of rejection. However, the claim is rejected because the patient information was partially furnished. So, you file an appeal and after review, the payer agrees to reimburse the costs for the treatment that wasn't covered earlier. Hospitals constantly think of ways to make the process of rebilling faster and simpler.
What exactly causes claims denial? It is important to understand the challenges associated with denial management before evaluating the best practices to prevent denial of claims.
Top 4 Healthcare Claims Denial Management Challenges
Claims denial is a challenge that most people prefer not to experience. It can also affect healthcare providers because they may be forced to adopt a dedicated system for claims management. The top 4 challenges in claims denial management are as follows -
Claims Denial Rate is Affected by Varying Payer Rules
The payer may furnish various rules and criteria. Hence, it is important to track denial statistics to lower the chances of rejection. However, obtaining statistics is easier said than done. Payers are often protective of claims denial data because of competition as well as the risk of clients choosing a different payer offering a lower denial rate. All payers follow exclusive, non-standard rules for denying claims as well as a method to communicate with providers.
Using Manual Process for Claims Management Delays Reimbursement
Many providers have an inventory of healthcare IT tools to centrally handle operations ranging from patient care to management functions. However, 31% of the providers still handle hospital denial management manually. This can delay the overall time taken for the patients to get reimbursed while pushing the cost for providers.
Claims Denial Reoccur Despite Being Avoidable
Accuracy of information must remain consistent right from the initial stage where the patient schedules a consultation. However, providers are making the same mistakes over and again resulting in rejection instead of payments. Medical billing and claims management is reactive to the accuracy of the data.
Appealing Claims Eats Away Provider's Time and Money
Irrespective of the measures taken by providers to avoid mistakes, the chances of claims rejection cannot be eliminated. However, that is not to say providers must stop filing reimbursement claims. In case the claim is rejected, providers can always follow up with an appeal process. However, the appealing process may not be an easy choice. Providers can be set back by tens of thousands of dollars making phone calls, appeals, and investigative work. They can also take a long time to reach an amicable solution.
6 Best Practices for Ideal Hospital Denial Management
Streamlining the claims denial process is a priority for hospital revenue cycle professionals because it boosts revenue generation while making patients feel satisfied. Also, it would give fewer reasons to worry about denials in the future. Our 6 best practices for hospital denial management will help generate more revenue for healthcare organizations.
Here are the top 6 claims denial management best practices for hospitals -
Outsource Denial Management Services to Flatworld Solutions
Flatworld Solutions (FWS) have 19 years of qualitative and quantitative experience in Denial Management services. We have a team of experienced insurance sector professionals, subject matter experts, and dedicated project managers who can cater to your requirements with precision. FWS is an ISO-certified company with several global offices that are well-equipped with the latest technology infrastructure.
We follow best practices for managing hospital denials so that the reimbursement process is seamless. We ensure the safety of your data by authorizing only qualified professionals to work on the project. If you have time constraints, fret not! We are the people who can ensure the completion of your project within the agreed time limit, in a cost-effective manner.
Contact Us to outsource denial management requirements. Our team will follow up with a customized quote within 24 hours.
Avail best-in-class services at affordable rates
Structure Healthcare Customer Testimonials HIPAA
@ Flatworld Security
@ Flatworld Medical
Billing Process Medical Transcription Process Flow Medical
Coding Process Medical
Claims Process Charge
Entry Process Medical Records
Indexing Process Medical
Billing Software EMR Software
Development FAQs on Outsourcing
Healthcare BPO FAQs on
Teleradiology Services Healthcare
Fraud FAQs FAQs on Medical Accounts Receivable Services FAQs on Outsourcing Claims Adjudication Services FAQs on Healthcare Call Center Services FAQs on Ambulance Billing Services
- Flatworld Solutions Provided Outstanding AR Calling Services to a US-based Client
- FWS Delivered Medical Transcription Services to a Leading Healthcare Research & Consulting Firm
- Flatworld Provided Patient Onboarding Services to a US-based Pill Provider
- Flatworld Provided Teleradiology Services to a Medical Imaging Company in Fremont
AHIMA Healthcare Convention 2016 Read More