6 Best Practices for Hospital Denial Management
What will you do if your medical claim has been denied? Does it mean the end of the road for getting reimbursed? How do claims get settled after making an appeal? These are some of the questions asked by those who apply for claims. However, we have the answers for you. But before that, let's look at what hospital denial management is, as well as claims denial management challenges that pervade the system.
Imagine you are hospitalized for illness, and after treatment, you are filing claims hoping all is well and your valuable money will be reimbursed because the payer promised treatment coverage with low rate of rejection. But the claim is rejected because the patient information was partially furnished. So, you file an appeal to appeal their decision and eventually after review, the payer agrees to reimburse the costs involved in the treatment that wasn't covered earlier. Hospitals constantly think of ways to make the process of rebilling faster and simpler. Hence, we present 6 best practices for claims denial management that will help hospitals to handle claims denial in a professional way.
Top 4 Healthcare Claims Denial Management Challenges
Claims denial is a challenge that most people prefer not to experience. It can also affect healthcare providers because they my be forced to adopt a dedicated system for claims management. The top 4 challenges in claims denial management are as follows -
Claims Denial Rate Is Affected by Varying Payer Rules
The payer may furnish various rules and criteria. Hence it is important to track denial statistics to lower the chances of rejection. However, obtaining statistics is easier said than done. Payers are often protective of claims denial data because of competition as well as the risk of clients choosing a different payer offering a lower denial rate. All payers follow exclusive, non-standard rules for denying claims as well as a method to communicate with providers.
Using Manual Process for Claims Management Delays Reimbursement
Many providers have an inventory of healthcare IT tools to centrally handle operations ranging from patient care to management functions. However, 31% of the providers still handle hospital denial management manually. This can delay the overall time taken for the patients to get reimbursed while pushing the cost for providers.
Claims Denial Reoccur Despite Being Avoidable
Accuracy of information must remain consistent right from the initial stage where the patient schedules a consultation. However, providers are making the same mistakes over and again resulting in rejection instead of payments. Medical billing and claims management is reactive to the accuracy of the data.
Appealing Claims Eats Away Provider's Time and Money
Irrespective of the measures taken by providers to avoid mistakes, chances of claims rejection cannot be eliminated. However, that is not to say providers must stop filing reimbursement claims. In case the claim is rejected, providers can always follow-up with an appeal process. However, the appealing process may not be an easy choice. Providers can be set back by tens of thousands of dollars making phone calls, appeals, and investigative work. They can also take a long time to reach an amicable solution.
6 Best Practices to Arrive at an Ideal Hospital Denial Management Solution
Streamlining the claims denial process is a priority for hospital revenue cycle professionals because it boosts revenue generation while making patients feel satisfied. Also, it would give fewer reasons to worry about denials in the future. Our 6 best practices for hospital denial management will helps generate more revenue for healthcare organizations.
Here are top 6 claims denial management best practices for hospitals -
Outsource Denial Management Services to Flatworld Solutions
Flatworld Solutions (FWS) have 17 years of qualitative and quantitative experience in Denial Management services. We have a team of experienced insurance sector professionals, subject matter experts, and dedicated project manager who can cater to your requirements with precision. FWS is an ISO-certified company with several global offices that are well-equipped with the latest technology infrastructure.
We follow best practices for managing hospital denials so that reimbursement process is seamless. We ensure the safety of your data by authorizing only qualified professionals to work on the project. If you have time constraints, fret not! We are the people who can ensure the completion of your project within the agreed time limit, in a cost-effective manner.
Contact Us to outsource denial management requirements. Our team will follow-up with a customized quote within 24 hours.