4 reasons why your practice needs a denial management strategy

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Have you noticed an increase in denied claims? Has your staff been able to investigate these denied claims to resubmit or appeal for approval?

Whether the number of denied claims has increased over a short or long period, it is certainly something that requires immediate attention.

Your practice relies heavily on approved claims for maximum revenue, so it’s imperative that denials are kept to a minimum.

Every practice’s denial management strategy may differ slightly, but the general strategy should involve the following steps:

  • Review
  • Identify
  • Track
  • Mitigate

1. We Review Denied Claims

Insurance claims can be tedious, especially if your claims department is not well-averse in updated medical codes and unable to catch errors on-the-spot.

A third-party medical coding auditor would be highly beneficial, where with their extensive background in coding trends and revised guidelines, can review your denied claims with a fresh set of knowledgeable eyes.

2. We Identify Errors

Once the denied claims have been reviewed, the auditors can identify the most common coding mistakes and the top reasons for denials.

In today’s era of ICD-10, it is crucial for medical practices to understand and follow the updated medical coding guidelines, as this can be the difference between a successfully-processed claim and a denied claim, and therefore, gained or lost revenue.

3. We Track Unpaid Claims

Once errors have been identified, the auditors can work with your team to fix the errors, resubmit and appeal the denied claims, then track and follow up on unpaid claims to minimize lost reimbursements.

4. We Mitigate Future Denials

Although some claim denials are inevitable, the last, yet most important step going forward is to mitigate future denials and delayed payments.

The first step is typically to move your practice from paper records to an electronic medical records (EMR)-based system for optimal automation and reporting. This can greatly reduce the number of errors by human error and simplify your claims process overall.

By implementing a long-term automated workflow that minimizes coding errors, you are setting up your practice and claims department for success by preventing errors before they happen.

How Can MedEffect Help You?

MedEffect Strategies has a highly-experienced team of medical coding auditors who have direct, hands-on experience with helping practices in numerous fields implement a successful denial management plan.

We can see your plan from beginning to end and provide your staff with comprehensive training, guidance, and resources necessary for long-term success.

Schedule Your Free Analysis

If you have any further questions regarding denial management or would like to schedule a third-party audit of your denied claims, contact us today!

Let us take care of your business so you can get back to taking care of your patients.

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