Medical Billing Claims –Revenue Cycle Denial Management

Medical Billing Claims –Revenue Cycle Denial Management

If your medical practice is experiencing denials of claims, and all do to one degree or another, then you’ll need your medical coding and billing professionals to practice revenue cycle denial management. Proper and comprehensive management of claim denials is the major way in which one is able to capture revenue on claims they might never have honored.

Strategy for Revenue Cycle Denial Management

You’ll need an effective and thorough strategy for revenue cycle denial management. That strategy involves all involved in medical coding and billing, including healthcare workers, those processing information, and those submitting claims. Along with utilizing a strategy, which should include quick and timely communication concerning denials, including a process for deciding which you will appeal and which you will not pursue, you’ll need to be able to measure how successful you are at reversing payer’s original decisions. Quantified results are important.

Results of Management

With solid revenue cycle denial management, you can experience great results. Cash flow can be increased and accelerated, turn around on new claims may speed up, as you address any issues that may have gotten past claims rejected, and better management of all areas concerned with billing may occur, as you find and fix holes in your system. Thus, revenue cycle denial management isn’t just about getting reimbursed on claims that have been turned down, but it is also about creating a more effective and efficient coding and billing system.

It is very important when involved in revenue cycle denial management that you track all aspects of the process. Reporting must be be comprehensive so that you get a clear picture of problems and challenges, rate of success, and why denials occur. A solid goal is to reduce your first time denials by 50%. This is certainly achievable, as many claims are rejected due to a lack of information or improperly reported data.

Communication and Dedicated Effort

Using the right approach can increase payments of denied claims from five to 20 percent. It’s important that you and your medical coding and billing team have a clear path of communication in order to meet appeal deadlines and to make sure that claims that are resubmitted are correct. Dedicating efforts to making sure claims are correct the first time is important, as is ensuring that you do everything possible to submit a clean claim when you appeal. All of these efforts will result in effective and successful revenue cycle denial management.

Address it Today

If you do not have a system in place for dealing with revenue cycle denial management, then start to address the issue today. This is an important financial key for any healthcare related business. Have your present medical claims submission process audited and analyzed, focus on problem areas, and institute a method for dealing with denied claims in a timely manner. In a few months time, you will see results.

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