Denial Management


billing and coding services

Denial Management System

A major issue for Medical practices has been denied medical claims. Even though the work was completed; the payer, through some technicality, refuses to pay. Manual denial management is a daunting task. Figuring out why a claim is being denied by a payer is a costly and time-consuming venture. According to the Medical Group Management Association (MGMA) It costs $25 to $30 to manage the average denial. To counter this, Human Medical Billing follows the following protocol to minimize denials and improve the collections of a practice.

Main features of Human Medical Billing and Coding Services Denial Management System

Charge Entry Analysis – Checking claims in real-time to verify CPT and ICD codes and to ensure that they are in compliance with the payer’s guidelines.

Sophisticated Rules Engine – We track payer denial activity and identify new rules. So that repeat errors are not made.

Claim Alerts – We receive Automated responses for events like claim re-submissions and claim status which ensures payment transparency and also makes sure that money doesn’t fall through the cracks.

In-Depth Analytics – Customized real-time reports are run to make sure claims are being paid in full and also to identify areas where improvements can be made.

AA recent study by People-to-People Health Foundation discovered that it was costing medical practices an average of $68,274 per physician per year to interact with patient health plans. Human Medical Billing supports our clients to avoid this by being hands-on and efficient. We can provide billing and coding services to help prevent any future medical billing troubles.

Main Functions of Human Medical Billing Denial Management System

Maximizing Revenue – Monthly reporting identifies causes of greatest financial impact and generation of cash flow.

Identifying the root cause of denials – Collecting and interpreting denial patterns to quantify denial causes and their financial impact.

Having accurate workflow priorities and scheduling for follow up – Collecting information on denial appeals, including status, escalation, correspondence with payers, and the disposition of denial appeals to increase recovery amounts.

Providing accurate and timely statistics for Clients – Providing management analysis reports and other information to prevent future denials.

Track, Prioritize & Appeal denials – Generating appeal letters based on federal and state statutes and case citations favoring the medical provider’s appeal.

Avoiding untimely filing.

Analyzing the effectiveness of denial resolutions.

Creating innovative and efficient business process improvements to avoid future denials.