Denial Management

One of the biggest worries for physicians, doctors and other healthcare professionals is the denial of medical claims. In the US, a common best-practice recommendation is to have 4% denial rate or less. Such denial rates, for many organizations, could lead to unrecoverable operational losses.

At Keoch IT Solutions, we analyse your data to expose the root cause for all denials. To optimize revenue and eliminate recurring denials, we assist you to identify and implement process improvements.

Stages of denial management at Keoch IT Solutions :

• Key denial reason identification : We begin by identifying the fundamental reasons for the denial of the claim. The payer returns a status code along with the reason for remittance when adjudicated claims are returned unpaid. An exhaustive investigation of billing management and procedures may be required to understand the hidden persistent reason behind constant denials. This stage concludes with ideas on where to look for issues for quick reduction in denials and accurate claims management.
• Denial categorization : The next step is to organize the denials so that they can be observed and directed to the suitable department for remediation, thereby helping to identify opportunities to review processes, re-educate physicians, clinicians and employees or regulate workflows.
• Tracking mechanism establishment : Soon after organizing the reason for denial, we cultivate a tracking/reporting mechanism to easily ascertain the following information :
  • Impact of top denial categories on the organization.
  • Impact of top payers with regard to claims dollars denied on organizations.
  • Impact on Top departments/service areas by denied claims.
• Preventing and monitoring : To avoid incessant revenue leakage, denial management programs must be continually assessed and monitored.

Strategies to reduce denials at Keoch IT Solutions :

To reduce the number of denials and improve the medical billing processes, every organization needs to take some steps. At Keoch IT Solutions we take the following steps:

Patient eligibility determination : Even before the patient is admitted, our practice management system is competent to verify benefits and eligibility.

Prior authorization : To ensure your staff knows when to obtain authorization before delivering a service, we investigate prior authorization needs for in-office services often ordered during the patient’s visit.

Coding errors reduction : We take active measures to minimize coding errors, identify services commonly served by your organization and seek advice from a professional on how to code those services.

Medical necessity determination : We use softwares that edit charges for a coverage determination to avoid denial of claims.

Smart Pave solution’s efficient internet-based denial management in medical billing applications can assist you to effectively analyse remittance advice. This reveals an opportunity for efficient denial prevention.

Rely on us for :

• Single, on-demand view for mapping all aspects of claim denials and receipt of re-submission.
• Claims denial management from all payers.
• Drive initial denial rates below the industry best practice of 4%.
• To measure the impact of process improvements, provision of key trending reports.
• Full compliance delivery with HIPAA privacy provisions and technical security.
• Quality services provision at cost-effective rates within a quick turnaround time.

At Keoch IT Solutions, we also provide other billing solutions like submission of claims, Mental Health Billing Services, Patient Demographics Entry and more.