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Business Outsourcing Take Control of Your Medical Billing Denials
Business Outsourcing Take Control of Your Medical Billing Denials
| Take Control of Your Medical Billing Denials |
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| Written by Carl Mays II |
| Saturday, 29 November 2008 11:04 |
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Twenty Percent. This is how much of your practice or facility's collections you are allowing payers to keep if you are not properly tracking and pursuing medical billing denials. This is a lot of money during the best of times, but particularly during tough economic times. Your practice needs an effective Revenue Cycle Denial Management system if you want to recapture this lost income. Some medical billers believe denial management is the same as follow-up, others believe denial management is primarily geared towards dealing with issues around medical necessity. Many medical billing experts simply think as denial management as a description for the overall medical billing process. A good start to finding out if your practice is suffering from improper denial management is to find out from your medical billing service (or in-house medical billing manager) how they manage denials and how they measure success in this area. 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. With the analytical capabilities available, the medical billing department or medical billing company can identify systemic medical billing problems, create and test solutions to the problems and implement process changes that will increase collections AND drive down medical billing costs. One example of this is pursuit of Clean Claim Law violators with the denial data produced from the denial management system. 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 Co-Founder of ClaimCare Medical Billing Services, a medical billing company with clients throughout the United States. Carl has been helping 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 the rest of Carl's articles on medical billing. Kindly provided by MoneyHunter.org You are welcome to use this article on your own website, if you include the link just before this text. |
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