The Importance of Denial Management
Operating a healthcare organization means you’ll have a lot on your plate. One of the many things you’ll need to consider is revenue cycle management (RCM) and claim denials. There are many reasons why an insurer might reject a claim, such as improper filing, inaccurate information, or omissions.
You require a system that helps your healthcare organization stay on top of things. On the one hand, you’ll want to stop or reduce the number of denied claims. On the other hand, you’ll want to figure out the root cause behind any denied claims.
Understanding denial management is vital. So, continue reading to learn more about what it is, why it’s so essential, and how outsourcing denial management can help your healthcare organization focus the attention on the patients you’re in business to serve.
What Is Denial Management?
Denial management involves going over every denial, carefully assessing why each claim was rejected, looking into patterns to find any trends among insurers, and implementing changes to stop or reduce the odds of claim denials in the future.
When insurers deny claims, that’s not merely an inconvenience. It will also negatively impact efficiency and productivity, since your administrative staff must dedicate more time and effort to correcting mistakes. Depending on the extent of the changes needed, this extra work could come at the expense of other tasks.
You’ll also have to deal with the impact of claims denials on your patients. They won’t appreciate waiting for reimbursements and might blame your healthcare organization for delays.
Types of Healthcare Denial Management
It’s also vital to understand the various kinds of denials that your healthcare organization might receive from insurers:
Soft Denial: If you’re going to get a denial, this is the one to get. It requires no appeal. A soft denial is a temporary denial that will automatically be reversed if your healthcare entity performs the requested action.
Preventable Denial: You might get this type of denial because of invalid codes, registration errors, and insurance ineligibility.
Hard Denial: A hard denial is a rejection leading to a write-off or lost revenue. You’ll have to appeal a hard denial.
Administrative Denial: If you get this denial, the insurer will notify your healthcare organization and specify why the claim was denied. You can likely file an appeal.
Clinical Denial: It’s a hard denial triggered by a lack of payment. An appeal is required for a clinical denial.
One thing to understand is that frequent denials are often due to a lack of proper denial management policies. With the right strategy in place, you’ll easily be able to uncover the primary causes and avoid them in the future. A proper revenue cycle management (RCM) solution from a provider of denial management services will get your healthcare organization on the right path.
Why Is Denial Management for Hospitals Essential?
You can eliminate or reduce claim denials if you have the right plan. It’s about being proactive rather than reactive. Keep reading to learn more about the benefits of implementing a claim denial strategy.
It’ll Help You Get Started on the Right Foot
When your business invests in hospital denial management, you’ll get to start things off on the right foot. Administrative staff members can register patients by entering the information needed to ensure timely reimbursement. You’ll have the details required to file accurate claims fast.
Adhere to Deadlines
A denial management solution will ensure that claims are filed on time. When you have a critical mass of claims that need to be submitted by specific deadlines, it’s easy for things to fall between the cracks. That’s especially the case if the process is done manually. You don’t want claim denials due to not submitting on time.
Understand the Reason for Denials
Denied claims can be a nightmare, especially if you’re not sure why they were denied in the first place. With a denial management system, you can drill down to the heart of the matter and determine why claims were denied.
Bolster Revenue Collection
A good denial management plan can help your healthcare practice increase revenue collection. How can healthcare dental management help your organization with revenue collection? It will streamline medical billing and coding through automation, enhancing workflow. More efficiency will lead to better productivity.
Keep Up With Changes
One thing you don’t want is to fall behind when it comes to industry changes. That can lead to penalties and reputational harm. Regulations and rules sometimes change, and you’ll want to stay abreast of any changes. A denial management strategy will ensure that you’re not taken by surprise. You’ll get notifications if any changes impact how you file claims or what information is needed.
A denial management system will help you avoid making mistakes in claim submissions. But if the system does detect any claims issues, it will notify you sooner rather than later. That can help you make corrections before claims are denied. It’s about nipping the issue in the bud before a minor issue becomes a big problem.
How Horizon Healthcare Can Help
At Horizon Healthcare, we understand that effective accounts receivable denial management is a must. Your healthcare organization needs it to maintain a healthy cash flow and remain in good shape. But doing it in-house will mean spending less time on your healthcare organization’s primary goal—providing quality patient care.
Our outsourced denial management services solution is the answer. Let us help you address payer denials so that you can devote your attention to patients. Your staff can focus on the key responsibilities you hired them for while we handle denial management. Are you interested in learning more about how we can help with your healthcare organization’s denial management needs? Give us a call to get the help you need.