Most healthcare providers now prefer working with third-party RCM service providers because, honestly, RCM is highly challenging and needs the right mix of experts and technology to tackle. Denial management services is a part of general RCM services and is offered by most good RCM service provider. As a practice wanting to bring down your denials rate dearly, here are smart ways to optimally use denial management and get the best out of it.
- Denial pattern analysis
One of the best uses of denial management services is to find out what’s happening at the root level, and denial pattern analysis is a great way to achieve this. Denial pattern analysis is the process of understanding the root causes of the problem and finding a pattern in the denied claims.
When patterns are spotted, it becomes easy to know what the major causes are to be tackled first.
- End-to-end denial management
Some denial management service providers promise denial management but stop identifying denied claims, sorting them as hard or soft denials, and implementing pre-set strategies to appeal to soft claims. This isn’t a very effective procedure though.
A good denial management service team will offer more than just these. The team would go on to do a root-cause analysis for all the denials and identify the exact problem. They would then communicate the same to the internal billing or coding team and get them to correct the issue. The team wouldn’t close a denial case unless a solution has been obtained – the claim either successfully reimbursed or the claim was written off.
- Proactive denial management
What does being proactive mean? It means anticipating a potential problem and taking steps to prevent it, even before it has occurred. Proactive denial management is needed to win in today’s competitive environment.
Proactive denial management services require an exceptional understanding of the payers in question, their needs and demands, and knowing what changes would improve the chances of reduced denial rates in the future.
- Real-time denial tracking
Another great way you could use the optimal use of denial management services is to ask for real-time denial tracking. This is a process where the denial experts create a tool that can track all denials and their statuses in real-time. This way, the client can clearly see what’s happening with a particular claim at any point in time.
The tool will tell if the denied claim has been resubmitted, processed, or approved/denied so they can keep track of their finances.
- Long-term solutions
Choose denial management services that promise long-term results instead of immediate solutions. Let's say denial management team A promises a 10% reduction in your denials at the end of month 1. Denial management team B promises a gradual decrease in the denials rate. It starts with 3% on month one, but the results compound over the next few months, and at the end of month six, the denial rate is reduced by 30%.
The problem is that most clients choose service provider A because they see better results in the short term. However, long-term solutions are more critical.
Conclusion
If you ensure these five processes are in place with your denial management process, it would automatically mean your denial rates drop organically over time, and you have fewer write-offs each month. Hiring the right denial management service experts is the first step to achieving this.
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