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.
Revenue Cycle Denial Management has become a universal and often abused term in medical billing. Some individuals use the term to describe a means of addressing claims denied for medical necessity. Others use the term to describe how some information is tracked for a specific payer, set of procedures or a place of service. Still others try to use it to describe what they do daily in the physician's office.
Given all of this confusion, how do you find out if your medical billing company or medical billing department is utilizing proper denial management for your practice? A good start is to ask a few simple questions: What do they believe denial management entails? What metrics do they utilize to measure denial management success? How much have they increased your collections in the past 6 months through their denial management system?
Few billing departments appreciate the value a good Revenue Cycle Denial Management system can bring to a medical practice or facility. A robust Revenue Cycle Denial Management system provides methodical management data for the billing process; the data are then used to (a) increase and (b) accelerate cash flow.
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.
Three elements are typically missing from a practice or medical billing company's denial management process: data, filtering/sorting methodologies and feedback to systematically correct errors. Most practice management systems do not properly track denials - at least not in the form in which they are typically used (i.e., they may have the capability, but only if properly implemented and used). Those PMs that do track denials typically overwhelm the practice with data that is difficult to utilize for high level denial management. Finally, even if the data is captured and can be properly utilized, most billing groups do not have a systematic way to get the information back into the billing process in a manner that prevents the denials from occurring again in the future.
A proper medical billing denial management system tracks every claim that has denied and can report this by payer, by CPT, by physician and by diagnosis. This information must be presented in a manner that allows fast identification of trends. With this powerful combination in hand, the medical billing department of medical billing service can then utilizes claim rules and edits that are specific enough to dramatically drive up the first pass claim acceptance and stop the flood of denied claims.
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.
If you implement a powerful denial management system you can optimize your medical billing and speed up your cash flow. As previously mentioned, a strong denial management system can increase your collections by 20 percent or more.
Copyright 2008 by Carl Mays II - 15431
Revenue Cycle Denial Management has become a universal and often abused term in medical billing. Some individuals use the term to describe a means of addressing claims denied for medical necessity. Others use the term to describe how some information is tracked for a specific payer, set of procedures or a place of service. Still others try to use it to describe what they do daily in the physician's office.
Given all of this confusion, how do you find out if your medical billing company or medical billing department is utilizing proper denial management for your practice? A good start is to ask a few simple questions: What do they believe denial management entails? What metrics do they utilize to measure denial management success? How much have they increased your collections in the past 6 months through their denial management system?
Few billing departments appreciate the value a good Revenue Cycle Denial Management system can bring to a medical practice or facility. A robust Revenue Cycle Denial Management system provides methodical management data for the billing process; the data are then used to (a) increase and (b) accelerate cash flow.
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.
Three elements are typically missing from a practice or medical billing company's denial management process: data, filtering/sorting methodologies and feedback to systematically correct errors. Most practice management systems do not properly track denials - at least not in the form in which they are typically used (i.e., they may have the capability, but only if properly implemented and used). Those PMs that do track denials typically overwhelm the practice with data that is difficult to utilize for high level denial management. Finally, even if the data is captured and can be properly utilized, most billing groups do not have a systematic way to get the information back into the billing process in a manner that prevents the denials from occurring again in the future.
A proper medical billing denial management system tracks every claim that has denied and can report this by payer, by CPT, by physician and by diagnosis. This information must be presented in a manner that allows fast identification of trends. With this powerful combination in hand, the medical billing department of medical billing service can then utilizes claim rules and edits that are specific enough to dramatically drive up the first pass claim acceptance and stop the flood of denied claims.
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.
If you implement a powerful denial management system you can optimize your medical billing and speed up your cash flow. As previously mentioned, a strong denial management system can increase your collections by 20 percent or more.
Copyright 2008 by Carl Mays II - 15431
About the Author:
Carl Mays is President & CEO of ClaimCare Medical Billing Services, a medical billing company with clients throughout the U.S. Carl has been helping clients with Medical Billing problems and practice management solutions for more than 10 years. You can learn more about world-class medical billing processes by searching for the rest of Carl's articles on medical billing.
