Our claim denial management audits help you to deal with the crisis, impact across revenue cycle KPIs.

1. How Claim Denial
Management Audits
Optimize your Revenue
Cycle?
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2. Introduction
● Most of the providers don’t know about the total number of claims
denied in the first phase.
● This is among the primary topics surveyed & discussed, and providers
are stunned by finding the cumulative percentage of revenue lost due
to those initial denials.
● The need for medical documentation and the absence of
authorizations are the most well-known reasons for claims
denials Insurance Eligibility Verification services permit to check the
coverage and benefit details there by reducing the denial percentage
of the practice.
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4. ● Increasing efficiency and improving billing collection rates should be
the foremost concern for healthcare providers with focus on availing
required prior authorizations and eligibility verification done before
the service is rendered.
● Claim denials are the refusal of an insurance agency to respect a
solicitation by a provider/person to pay for healthcare services got
from the healthcare professionals.
● The expenses related to not following up on the claim denials can
affect the businesses and cause inefficiencies within a provider’s
claims management and revenue cycle.
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5. ● Regular denial management audit helps you to identify the claim
denials reasons, Such as
○ Duplicate claim submission
○ Service previously adjudicated
○ Services not covered by the payer
○ Time limit for claim submission expired
○ Insufficient medical necessity
● Here a few claim denial reasons are discussed in detail:
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6. Insufficient Medical Necessity
● This can be a challenging situation for all parties, yet you might have
the option to avoid them.
● Regardless of where medical necessity isn’t obvious good
communication among patients and providers is important to make
the best decision on medical necessity.
● At the point when a claim is denied because of medical necessity,
your practice could be compelled to either assimilate the expense of
services or endeavor to gather the whole payment from the patient
neither of which are acceptable alternatives.
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7. Time Limit For Claim Submission
Expired
● One significant issue medical billers experience is when claims are
denied for the timely filling because each insurance carrier has
various rules and regulations for claim resubmission.
● So it is a difficult task for physicians and billing team to keep up with
the various timelines with each payor.
● To avoid this kind of issue outsource your medical billing to the best
medical billing company that specializes in denial
management and AR follow-ups.
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8. ● Claims are frequently denied for timely filling even when the claim
submitted on time however not got by the insurance carrier.
● There are numerous reasons this can occurs, yet the significant aspect
of the condition is how the biller responds to the denials.
● Other times, claims are denied for timely filing when they were not
submitted within the filing time frame because of initial errors.
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9. About MGSI
● MGSI is the best choice for medical billing outsourcing in Florida, US.
● We provide various services such as anesthesia billing, cardiology
billing, insurance eligibility verification services, etc.
● MGSI enables healthcare organizations and enhances the revenue
cycle to improve the quality of claims and decrease denials rate and
claim rejection.
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10. Thanks!
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Any questions?
You can find us at:
+1 (877) 896-6474
info@mgsionline.com
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