Medical claims are an important aspect of your practice’s revenue. When claims are refused, it can be a significant source of financial loss. Denied claims not only increase days of the revenue cycle, disrupting cash flow, but they can also cost you money if not resolved quickly. The cost of processing each refused claim further adds to the strain. Are you experiencing high denials, and looking for a sound strategy to manage these denials? It is important you understand why your claims are being denied, based on which you can devise a strategy to reduce further denials and keep your practice from losing revenue.

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How to Create an Effective Denial Management
Strategy
Medical claims are an important aspect of your practice’s revenue. When claims
are refused, it can be a significant source of financial loss. Denied claims not
only increase days of the revenue cycle, disrupting cash flow, but they can also
cost you money if not resolved quickly. The cost of processing each refused
claim further adds to the strain. Are you experiencing high denials, and looking
for a sound strategy to manage these denials? It is important you understand
why your claims are being denied, based on which you can devise a strategy to
reduce further denials and keep your practice from losing revenue.

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3. Types of Denials
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 Soft Denials – A soft denial is only meant to be temporary. If the claim is
amended and/or further information is added, it may be paid.
 Hard Denials – It is irreversible. It is revenue that has been lost since it
cannot be rectified or restored.

4. Reasons Why Claims Get Denied
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Identifying the cause for the denial is the very first step in an effective denial
management strategy. When evaluated claims are sent unpaid, the insurer will
usually explain why on the accompanying payment explanation. It’s vital to
remember that the majority of people are unaware of the insurance denial
process. It is your front office staff’s responsibility to emphasise the need of
precise documentation and insurance information.
 Service previously settled
 Service unqualified under a healthcare plan
 Missed deadline
 Incorrect/missing information
 Duplicate claims

5. The following pointers form the basis for an
effective denial management strategy
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1. Identify – Find and fix the problems that lead to claims being denied by
insurers.
2. Manage – Categorize denials according to their reason, source, cause, and
other distinctive characteristics.
3. Monitor – Keep track of denials, audit employees’ efforts, and give the
tools, technology, and resources needed to get the job done.
4. Prevent – Work with patients, recommending physicians, and others to
appeal and overturn unjustified denials.

6. Re-submit Claims in the Stipulated Period
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Follow your rejection management guide, evaluate the insurer’s associated denial
communication, and double-check your internal documents. If necessary, contact the
patient. Remember that most insurers have time constraints on resubmitting claims;
the last thing you want is to be denied reimbursement because of a late submission.

7. Examine the Denials
The easiest method to deal with claim denial is to prevent it from occurring in
the first place. According to industry sources, the typical denial rate for
practices is between 7 and 10%, whereas there should be no more than 4%
and no more than 2%. Preventive denial assessment is a root cause analysis of
all denials received with the goal of lowering the denial rate in the future.
Here are a few things you may to want to analyze –
 What was the source of the denial? Was it a billing error, a coding issue,
patient eligibility, the wrong payer was invoiced, or anything else?
 Is it possible that this denial might have been avoided? The solution to this
question will astound you.
 What could have been done to prevent the denial? Review your eligibility
verification procedure to see if it needs to be fine-tuned if it was an
eligibility issue.
 Perform an 80:20 analysis of your denials to determine which issues are the
most bothersome and how they might be rectified.
 Don’t try to change all of your processes at once; taking it one step at a
time will yield better outcomes.

8. Organize the Process
The denial management procedure should begin as soon as a denial is
discovered. This entails the steps below.
1. Directly route denials to the affected individual’s work list. A coding error,
for example, must be reported immediately to the coder.
2. Sort the assignments on the denial work list by cause, time, and cash
amount
3. Remember to act quickly to avoid automatic re-billing and to strengthen
your case.
4. Create a denial management manual for your workers and create a uniform
methodology for each major type of denial.

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Denial management is a continuous effort for all healthcare facilities, and it takes up a
lot of staff time. You can lower your denied claims by offshoring your denial
management process to a revenue cycle management business. Info Hub provides
custom-tailored systems and reporting tools for each client. To help you enhance your
bottom line, we offer the full range of revenue cycle management services.
We work with you at Info Hub, an offshore medical billing firm, to reduce denials and
underpayments, manage claims, improve patient eligibility verification and payment
collections, and reduce compliance concerns and risk. Contact us to improve the
efficiency of your daily revenue cycle and business processes.

10. About Us
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Though there are several common benefits offered by offshore medical
billing companies, but choosing the right medical billing partner plays a
vital role. Info Hub is one of the leading offshore medical billing companies
in Coimbatore, India, with sophisticated infrastructure and skilled
manpower that is highly experienced in multiple aspects of medical billing
and coding, to support healthcare practices grow heights and develop
consistency in generating revenue.
If you are looking to outsource your medical billing and coding services to a
reliable outsourcing partner, Info Hub is your ideal choice. With more than a
decade experience in providing excellent medical billing and coding
services, Info Hub has earned high client value by building trust with its top-
notch services. For a quick appointment, make a call to +1-888-694-8634 /
+91-0422-4212455.

11. Contact Us
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Info Hub,
Sf No 558/2, Udayampalyam Rd, Nava
India,
Coimbatore,
Tamil Nadu 641028
Call Us: +91 829-745-6441
Email Us At: inquiry@infohubservices.com