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| Denial Management - Don't Perform Medical Billing Without It |
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| Written by Carl Mays II | |
| Friday, 14 November 2008 | |
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A well designed and executed Revenue Cycle Denial Management system can improve a medical practice or facility's collections by up to 20 percent. If your medical billing team or medical billing company does not have a proper denial management system in place then you are, without question, losing money.
A well designed and executed Revenue Cycle Denial Management system can improve a medical practice or facility's collections by up to 20 percent. If your medical billing team or medical billing company does not have a proper denial management system in place then you are, without question, losing money. There is a lot of confusion about the definition of denial management. If you ask five medical billing experts what this means you will probably receive six answers. To find out if your billing department or a current billing company is deploying a Revenue Cycle Denial Management System on your behalf ask them: (1) What is their Revenue Cycle Denial Management strategy; (2) What process do they use to methodically measure it and (3) what are the quantifiable results of it. If you do not receive rapid, concise answers with clear metrics then there is not a proper denial management system in place for your medical billing. A good denial management system is not simply about working denials, it is about systematically gathering the data required to eliminate denials. Working denials is like pumping water from your basement when a pipe bursts. Denial management is about fixing the pipe so you no longer need to pump water from the basement. Achieving powerful results from denial management requires data, data and more data. Your denial management system must report and measure all claims that are being denied by your payers. With this level of data your medical billing specialists can fix the issues that are leading to the denials (whether it be issues with the claims or issues with the payers) and stop the torrent of unpaid claims into your medical billing process. Once you do this, then revenues for your practice will increase; probably by 10 to 20 percent. Although many practice management systems can properly track claim denial information, few systems have the rare combination of having been both properly implemented to track the data and properly understood to extract the data in a meaningful manner. Without both of these elements the denial management process cannot properly provide the feedback on denials that is required. Even when this information is present, often there is no mechanism for feeding the information back into the medical billing process to correct billing problems. The standard denial management output should track by payer, the number of claims denied and the reason for the denials. This must be coupled with a dashboard reporting tool for quick visual management. With these reports the billing team can easily identify which payers are inappropriately denying claims; they can also compare these payers to their peers for proper trending and follow-up. This output allows the medical billing team to develop and refine payer specific rules to prevent future payer denials by insuring all claims are clean when they are submitted. Payers that are chronic violators are pursued to resolve how and when they intend to process and pay outstanding claims. If the issues persist, there may be grounds to charge penalties stipulated by the Clean Claim Law. Only by quantifying and analyzing the problem can a medical billing team discover how to improve on the process. As previously mentioned, an effective denial management system is critical for your practice if you want to improve your medical billing and hasten your collections. Implementation of the proper system can easily increase collections by more than 10% and could even exceed a 20% increase in collections. Copyright 2008 by Carl Mays II About the Author: Carl Mays is President & CEO of ClaimCare Medical Billing Services, a medical billing company that serves clients across the U.S. Carl has been assisting clients with Medical Billing challenges and practice management solutions for more than 10 years. You can learn more about medical billing challenges and solutions by reading additional medical billing articles by Carl. |
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