It can adversely affect your cash flow if you receive a denial. If denials are managed promptly and effectively, this will result in an increase in cash flow and enhance the effectiveness of the billing process with a higher first-level pass. ussurance Health hub’s Denial Management Program is capable of recovering revenue otherwise lost due to past and future denials. Among the reasons for denials are:
o Insurance information that is inaccurate or incomplete.
o There is no pre-authorization code.
o Coding and charges errors and omissions.
o Filing a claim after the time limit has expired.
o There are errors with credentialing or the provider has not been enrolled.
We leverage data and trend analysis to carry out our Denial Management process at ussurance hub, which is critical to its success. Denials are tracked in a systematic manner and information is returned to the billing process to prevent similar rejections in the future.
Our services increase cash flow and reduce rejections by:
o Analyzing the volume of denials and the baselines
o Evaluation of denials based on age, expiration of the claim, non-compliance with the deadlines
o Calculating the percentage of denials based on payers, providers, CPT codes, and general non-compliance with ICD 10 standards.
Personal Data of the Patient
Please include the following information about your patient: Name, ID#, Gender, Marital Status, Email, Date of Birth, Social Security Number, Contact number, residential address and business address.
Guatantor / Account Details
Guarantee name, date of birth, work and home phone numbers, along with their respective addresses.
The following information is required: Insurance Identification Number, Name and Address of the Insurance company, Name or number of the group, Dates of the insurance policy and termination, policy number, Name of the insured, Date of Birth, and Relationship between the insured and the patient.
How does Denial Management work?
The process of managing denials is an important part of the Revenue Cycle Management process. When an Insurance company denies the payment of a claim, the healthcare provider cannot collect payment for the services rendered to a patient. Although, a Clinical Denial may be based on Coding Reactions, Medical Necessity, the Length of Stay, or the Level of Care in addition to other clinically related issues.
What are the industry standards?
Obtaining payment for these denials can be a difficult and lengthy process. Healthcare organizations must appeal clinical denials. A reworked claim costs an average of $25 per claim, according to research. The industrial average is a denial rate of 5% to 10%. The ultimate goal would be to ensure that this standard falls below 5% in order to maximize revenue for the organization.
Prevention rather than reaction
Assess your denial rate by using the formula: (Total claims / Total claims denied) Provide regular training to your personnel, as well as webinars Identify the problem areas and implement processes to solve them Evaluate your overall success rate by using a set of Key Performance Indicators
In what way does USSURANCE hub contribute to this process?
Medical denials affect a healthcare organization’s financial turnover and growth. A challenge often faced by healthcare organizations is managing staff training and frequent changes in payer requirements. It is not inevitable that denials will bring an end to a Practice, but taking control and eliminating denials will lead to an increase in revenue. It is important to locate a co-sourcing party who shares the same values as yours (Co-Sourcing).