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Helpful Tips on Denial Management

September 1, 2015 | 11:21 am
Published by | Krunal Popat

When it comes to effective healthcare claims processing, it is important to establish a system that maximizes efficiency to process denied claims. All too often, health care providers are too inefficient when it comes to handling claims, especially those that are denied. In order to improve this particular process, it is important to recognize the potential income lost and establish an effective medical claims management service.

Here are five tips on how to properly process denied claims and improve the overall performance of this aspect of your services.

Keep Track of All Claims

This may seem like basic advice, but the truth is that too many health care providers let claims fall through the cracks and get lost. This is because there are not enough people or resources available to properly keep track of all the claims that have been submitted. The only way to truly address the problem is to use efficient process that will help employees keep track of denials so that they do not get lost in the system.

Understand the Underlying Problem

This means that you will need to look over all the denials that have been made to try to pinpoint an area that might be a large cause of the problem. Spotting a particular issue that many denials have in common can lead to proactive steps where it does not happen again. This can save your practice quite a bit of time, effort and money in this regard.

Correct All Denials within One Week

If a claim is returned or denied because it was incorrectly submitted, then it needs to be corrected and resubmitted within one week and preferably faster if the correction is a minor one. In this manner, all denials get top priority and are addressed quickly so that they are not forgotten or pushed back. The longer that denied claims are not handled, the longer you will have to wait for your money. In addition, many health insurers place time limits for health care facilities to address denied claims, so this should be taken into account as well.

Document All Successes and Failures

By keeping track of the end results, your denials management healthcare system will provide your team with documentation that will demonstrate how well the methods used to claim money from denials has worked. While there is no perfect system, having such an overview will help get rid of ineffective methods and introduce new ones that perform better.

The good news is that even small improvements will make a substantial difference in the cash flow of the health care facility. The better the denials management, the more efficient the business will become.