Denial Management Services
Denial management in the medical billing process is a crucial aspect that investigates every unpaid or unsettled claim, addresses claim rejection, and re-appeal for the claim approval as per the provider’s contract. Since denial of claims has become one of the major concerns for any healthcare organization, denial management solutions are the need for an hour. For many organizations, denial rates could often lead to operational losses from which they would never recover again. To address this, professional denial management services can help in fixing denials as they follow the best practices to identify the causes that result in claim rejection, take appropriate measures to fix it & re-file for medical claims.
SunTec India is a leading healthcare BPO offering a full suite of medical billing services that include patient demographics entry , medical coding, charge entry, AR follow-ups, claims status checks, denial management, etc. to help you collect all amounts due you for medical services rendered. Our healthcare denial management services are focused on uncovering the root cause for all denials and take appropriate measures to get it approved in re-filing the insurance claim. Our denial management team analyzes, reports denials, identifying problems, and implements solutions for denied claims while helping you to eliminate recurring denials and optimize the revenue cycle.
What Causes Claims Denial?
There are numerous issues that can arise causing claims denials. Some of the key reasons for denials in medical billing are -
Incorrect/inaccurate patient information
This could arise due to simple mistakes like a misspelled name that results in wrong information passed on by the patient
Invalid medical code
In many cases, this is the reason for denials. If the codes are wrongly entered, it leads to a contradiction in the entered codes and medication used.
Lack of documentation
Sometimes, even the lack of documentation support or counteracting documents leads to medical insurance claim denials.
Non-covered ailments
If the ailments are not covered under the insurance policy, the claims often get rejected. Thus, it is important to talk to the patient's insurer before conducting the treatment, to get a clear idea of the type of claims receivable
Pre-authorization or precertification cases
Failure to confirm insurance eligibility and get prior authorization may often cause delayed payments and denials.
Denial Management Solutions We Offer
Some of SunTec India’s denial management services include -
Identifying the cause of denials
As the first step, we identify the root cause for the denial of the claim. When adjudicated claims are rejected or denied, the insurance company returns a status code along with the reason for the remittance. Our team of medical billing experts understands the key reasons behind constant insurance claim denials and accurately examines your billing procedures and management. In identifying the reason behind denial, our team fixes the issue for faster reduction in denials and effectively handles your claims management.
Classify & sort the denials
After identifying key reasons for your claim denial, we categorize the denials to monitor and route them to the suitable department for remediation. Additionally, categorizing, sorting, and analyzing denials enables us to identify opportunities to revise processes, adjust workflows or educate employees, physicians, and clinicians.
Make reports for assessment
After categorizing the reasons for denial, we develop reports for accessing and reporting to ascertain information like top denial categories impacting the organization, payers that are most impacting the organization in terms of claims denied, etc.
Monitoring and preventing denials
Since Denial management should be part of every healthcare organization to prevent revenue loss, we continuously monitor and assess denials from insurance companies. Our team analyzes denial information, reviews trends, and determines which categories to address first, and comes up with a resolution. We continuously work on the prevention of denials and management of denials.
Understanding insurer's norms & procedures
Other than claims denial management, our team has worked with many insurance companies that make us adept at their standard and unique procedures. This makes the process easier as the entire billing preparation and other claims documents are prepared as per the insurer's norms leading to faster payments.
Why Outsource Denial Management Services For Medical Claims?
Many facilities and healthcare organizations fail to manage denied claims and resubmit them due to a lack of time and expert knowledge. As Denial Management requires expert knowledge and timely execution, outsourcing denial management services are the best solution. With a team of professionals possessing expertise in clinical data management services, we can handle denials in a prompt and timely manner. When you outsource denial management services for hospitals, these professionals can effectively analyze the possible denial trends and fix issues to prevent a repetition of the denials. An expert denial management team can quickly help you track denials, address main causes, and execute denial management prevention strategies efficiently.
Other reasons why you should outsource Denial Management Services for Hospitals are:
- When you outsource denial management services, the medical billing teams check your data accuracy and also look after the insurance company’s rules and codes.
- The denial management process from a reputed and experienced firm can improve your productivity by managing denials successfully.
- Outsourcing healthcare denial management services for medical claims
- Helps you in keeping up with the codes and different policies of the insurance companies.
- An outsourcing company with relevant experience offers quick services & meets assured requirements, and frees you from tedious denial management tasks, helping you to focus on your core activities and patient care.
- An experienced medical billing team can help you identify errors before submitting the claims is possible through an automatic claim denial management process.
- Since an outsourcing company is well aware of the procedure, it can help you quickly get reimbursement and improve your revenue cycle considerably.
Outsource Denial Management Services to SunTec India and Get the Best Denial Management Experts on Board
With over twenty years of experience, SunTec India is a leading Denial Management Services company. Our streamlined Healthcare denial management services for medical claims and vast experience in medical billing services can notably bring down your claim denials by considerable margins. Through our clinical data management services, we have helped several healthcare organizations handle claims, monitor data, identify discrepancies, or increase payment recovery. Also, our team strictly adheres to regulatory norms and practices to avoid any breach.
Our denial management team can efficiently do an analysis of denials and follow-up on denials and partial payments to ensure a smooth cash flow. We thoroughly follow-up with payors, patients, providers, facilities, and any other participants on denied, underpaid, pending, and improperly processed claims and follow the most appropriate plan of action to fix them. As preventive measures for claim denial we also:
- Analyze & rectify the claim denial mistake, and re-submit the claim to the insurance company, accelerating the delayed & canceled payments.
- Ensure that the details of patient and insurance are accurately collected and reported before the final submission.
- Retrieve accurate information from patient scheduling and registration.
- Bill and collect the payments in the most effective manner.
- Understand the insurance providers’ specific requirements & procedure for quick reimbursement for the services rendered
- Verify and validate demographic details and insurance plans.
Why Outsource Denial Management Services to SunTec India?
Some of the key benefits to outsourcing denial management services in medical billing to SunTec India are -
Cost-effective denial management services
At SunTec India, we provide healthcare clients with affordable & cost-effective pricing options for denial management services. Additionally, our services can help you cut down your overhead costs & manpower.
HIPAA compliant services
We sign a HIPAA agreement with all our healthcare clients, so you can be rest assured that we have security measures intact and all your confidential patient-related data is kept safe
24/7 support
Our teams and services are available at your disposal round the clock, via email or phone to answer your queries or issues.
Latest tools & technology
At SunTec India, our medical billing team is well trained and equipped with the latest tools and technologies, to provide you the most accurate output without compromising on quality.
Experienced team of denial management specialists
We have the most experienced and skilled team of denial management specialists by our side who are proficient enough to handle all your needs and custom requirements.
Highest accuracy levels
SunTec India, prioritize and deliver accurate and error-free results. Furthermore, we have a dedicated QA team to handle a project and ensure that industry standards are met.
Experienced team of denial management specialists
We have the most experienced and skilled team of denial management specialists by our side who are proficient enough to handle all your needs and custom requirements.
Quick turnaround time
Outsourcing denial management processes to us can free your healthcare professionals from redundant claims denial tasks. Having the support of our skilled team we can deliver the most effective services within a short turnaround time. This will give you more time to focus on core operations and provide better care to patients
Scalable solutions
SunTec India has the required skills and expertise both in terms of proficiency and infrastructure to scale up the team size and services as per the clients’ requirements.
Get in Touch With Us for Denial Management Services Today!
To discuss your project or to learn more about our denial management services, please write to us at info@suntecindia.com and our team will get in touch with you shortly.
David Barrs, President
VisionSpan Corporate Communications, Inc., USA