A Look on Denial Management Services

According to a survey by AAFP (American Academy of Family Physicians), denials are a frequent occurrence accounting for between 5-10% of hospital claims. Denial Management Services Industry experts believe that in order to improve revenue flow, it is very important for providers to keep this number close to 5%. And in order to achieve this, they need to have a robust denial management process in place.

Why denials continue to be a challenge?

You will be surprised to know that there are quite a few number of providers who still use the manual denial management process. This not only creates room for errors but also slows down productivity.

  • According to a survey by HIMSS Analytics, at least 31% of providers still use the manual denial management procedure.
  • As per an article in RevCycle Intelligence, most providers or hospitals don’t have an effective denial management process in place, be it manual or electronic.
  • According to a blog post on Medical Group Management Association, only one out of three providers (35%) appeal denied claims.

Why do you need denial management services?

Every healthcare organisation needs to work on three fundamentals for denial management- prevention, analysis, tracking and trend management. It is important to understand why claims get denied, to streamline the denial management process, to track the progress and outsource the process, if needed.

With the right denial management services in place, it becomes easier to identify the most common reasons and trends for denials. Once the causes are identified, cash flow can be easily maximised.

Denial management experts implement the right technology that helps in handling denials effectively. They also use the best technology to determine whether or not a claim should be appealed.

From collecting data on denial appeals and analysing the effectiveness of denial resolutions to providing timely reports, with the right services, your practice can easily bring down the number of claim denials by a considerable margin.

Perks of Electronic Denial Management Process

Electronic claims denial management is the need of the hour because keeping up with the changes in diagnostics codes and insurance policies can be extremely exhausting for billers and coders. With the right software, codes and requirements are automatically updated.  This saves research time which can be then used by the billers to double check claims and ensure that all requirements are being met. Error-free claims will lead to zero denials.


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