Denial of medical claims is one the biggest concerns for doctors, physicians, and other healthcare professionals. A typical U.S. hospital can easily experience initial denial rates of 7-10% of its claims although a common best-practice recommendation is to hold the denial rate to 4% or less. For many organizations, such denial rates could often lead to operational losses from which they would never recover again.
Flatworld's healthcare denial management services are designed to sift through your data in order to uncover the root cause for all denials. Our team analyzes, tracks, and reports denials, identifying unpublished rules and recommending fixes for individual denied claims while helping you identify and implement process improvements to eliminate recurring denials and optimize revenue.
Our Denial Management Services
Given the industry-wide prediction of decreased revenue in the coming years, it is imperative for healthcare organizations to understand, quantify, and address the root cause of their current claim denials and establish a solid denial management process. Some of the key services we provide include -
Identifying Key Denial Reasons
The first step we undertake is to identify the key reasons for the claims denial. When adjudicated claims are returned unpaid, the payer will return a status code as well as the reason for the remittance. Understanding the frequent and hidden reasons behind constant denials may require complete examination of your billing procedures and management. After this is done our team at Flatworld knows exactly where we should look and fix the issue for faster reduction in denials and effective claims management
Categorizing the Denials
After identifying the denial volume and reasons, our next step is to categorize the denials so that they can be monitored and routed to the appropriate department for remediation. Sorting and analyzing denials by category will help identify opportunities to revise processes, adjust workflows or re-educate employees, physicians and clinicians
Establishing Tracking Mechanism
After categorizing the reasons for denial, we develop a tracking/reporting mechanism in which the following information can be easily ascertained -
Top denial categories impacting the organization
Top payers impacting the organization in terms of claims dollars denied
Top departments/service areas impacted by denied claims
Monitoring and Preventing
Denial management program is an ongoing process that must be continually monitored and assessed to prevent repetitive revenue leakage. Our denial management team at Flatworld Solutions helps to -
Create a multidisciplinary team that can analyze denial information and as a group review trends, determine which categories to address first, and discuss their resolution
Schedule regular meetings with the multidisciplinary team in order to focus on a specific denial category
Continuously monitor the adequacy of these internal controls against their effectiveness in the management and prevention of denials
Flatworld's Strategies to Reduce Denials
Every company needs to take some steps to improve the medical billing process and reduce the number of denials. At Flatworld, we use the following strategies to reduce the number of claims denials -
Determine Patient Eligibility
Our staff is trained to gather information about each patient's health insurance coverage and benefits eligibility. Our practice management system has the ability to verify eligibility and benefits even before the patients get admitted.
Obtain Prior Authorization
We create a process that ensures your schedulers get prior authorization for every service that requires it. We investigate prior authorization requirements for in-office services most commonly ordered during the patient visit so your staff knows when to obtain that authorization before delivering a service.
Reduce Coding Errors
With the transition to ICD-10 an increase in coding errors will likely lead to more denials. We take proactive steps to reduce coding errors, identify services commonly provided by your practice and then seek expert advice on how to code those services. Flatworld has coding specialists who review and verify codes before submitting each claim.
Determine Medical Necessity
Insurers may deny a claim because the diagnosis code given doesn't support the need for the service provided. To avoid this situation, we use software that edits charges for coverage determinations. We gather policies regarding medical necessity from all your insurers as well.
Why Choose Flatworld for Denial management Services?
Understanding the various causes of claim denials can increase long-term efficiency and drastically reduce lost revenue. Flatworld's highly-effective internet-based denial management in medical billing applications can help you efficiently analyze remittance advice, thereby revealing opportunities for effective denial prevention. You can rely on us to -
Provide all users with a single, on-demand view for managing all aspects of claim denials and receipt of re-submission
Manage claims denials from all payers
Drive initial denial rates below the industry best practice of 4%
Provide key trending reports to measure the impact of process improvements
Deliver full compliance with HIPAA technical security and privacy provisions
Provide quality services at cost-effective rates within a quick turnaround time
Flatworld Solutions - Hire the Best Denial Management Experts in the Industry
Flatworld Solutions accelerates the repair and re-submission of denied claims for cross-departmental teams for your organization. An intelligent workflow engine applies client-specific logic to efficiently distribute denied claims requiring re-submission to the right departments and individual team members, and maintains a detailed history of actions on all claims.