Five Ways to Better Denial Management for Physicians

Denial management is one of the crucial aspects for a physician and can assist in improving the revenue cycle management. This can not only reduce errors while managing claim denials but also help in increasing the physician’s revenue. This process is carried out by medical billers and coders who have specialized knowledge in the field and are aware of its legal aspects. Efficient denial management can increase the revenue in numerous ways; some of which are obvious while others enhance the revenue in an indirect manner.


Specialized medical billers and coders


Medical billers who are experienced and specialized in this field can perform better by utilizing their skills with incisive understanding of why the claim was denied in the first place. Specialized billers also represent your case strongly when the claim is correctly filed and the payer denies the claim on unclear grounds. Denial ratios are steadily increasing with payers in the given healthcare scenario.


Analysis


The best way to speed up the process of denial management is to analyze the grounds on which the claims are denied. Once the reason for claim denial is known, it becomes easier for medical billers and coders to correct the error and receive the deserved reimbursement. In Denial Management, Root cause analysis is more important than re-filing the claim.


Moreover, once the reasons for revenue leakage have been identified, any further loss can be pre-empted or stopped before it has occurred for the first time. Proactive Denial Management can increase the cash flow and the revenue by almost 10% by reducing the number of first-time claim denials.


Expertise


Denial management can involve communication with various entities and it is important to be trained in the process of collections from such entities. These involve recovering collectibles from any of the payers such as Medicare, Medicaid, BCBS, United Healthcare, Aetna and many local payers.


Appeals


A crucial part of claims denials is “appeals” and these are explanations for re-eligibility of the claim for payment which was denied earlier. Since these claims can only be appealed within a set period of time, it becomes important to prioritize them. Not every claim can be appealed thus this tool must be used judiciously. The Billing specialist must also possess the skill required to write appeal letters as the explanation with correction is what gets you paid in most cases.


Prioritize Denials as per value


Managing denied claims or appealing them can be made cost effective by reviewing the most commonly denied claims according to the dollar value and volume. This helps in determining which claims should be given the most importance and which are less likely to produce positive results. This can assist in cutting costs as well as saving time in the revenue cycle management.


Medical billing and coding specialists at medicalbillersandcoders.com are experienced in denial management and are skilled in other areas of medical billing and coding services such as charge entry, payment posting, credentialing, and managing accounts receivables.


For further information and medical billing and coding services please visit medicalbillersandcoders.com.


Ohio Medical Billing | Michigan Medical Billing | Maryland Medical Billing | Arizona Medical Billing | Washington Medical Billing | Oklahoma Medical Billing 

Five Ways to Better Denial Management for Physicians

Fraud and Abuse: A major reason for waste in the US healthcare spending

Health care fraud and abuse is an important and conspicuous factor in the resource and finance drain in the US healthcare system and is responsible, to an extent, for the escalating healthcare costs.


According to a report by Thomson Reuters on US healthcare spending, the US healthcare system wastes between $505 billion and $850 billion every year, out of which the waste caused due to Fraud and abuse constitutes $200 billion, or 22% of healthcare waste every year.


The following chart shows the percentage of waste caused due to different parameters in the US healthcare spending.



Source: Healthcare analytics, Thomson Reuters


What is healthcare fraud and abuse?


Health care fraud is a criminal act in which a consumer or physician(s) deliberately misrepresents facts or information, for the purpose of undeserved or greater reimbursement. Health care abuse is a reckless disregard or conduct that goes against and is inconsistent with acceptable business and/or medical practices resulting in greater reimbursement.


How to prevent it?


Health care fraud and abuse has played such a vital role in increasing the cost of health care and has become a pertinent issue for the government as well as the general public. The question is how to prevent it?
Both Consumers and physicians have to be alert to the possibility of fraud and abuse and work to prevent it. Consumers need to get involved with their health care beyond the point of going to the doctor and taking medication. They need to be educated on their insurance plan, how much they pay, the proper names of their ailments, and they need to keep track of the services they receive and why they receive them. Simple tips that may help prevent fraud and abuse include:


• Review Explanation of Benefits to ensure accurate dates of service, name of providers, and types of services reported
• Protect insurance card and personal information at all times
• Count pills each time they pick up a prescription
• Research providers with state’s medical boards
• Report suspected fraud and abuse as soon as possible


Along with consumers, physicians too must check for any unintentional fraud and abuse happening around them. They can have training and awareness amongst their staff to prevent unintentional fraud. These joint efforts would definitely check the fraud and abuse rate in the United States and ultimately bring down the overall cost of healthcare.

Ohio Medical Billing | Michigan Medical Billing | Maryland Medical Billing | Arizona Medical Billing | Washington Medical Billing | Oklahoma Medical Billing 

Fraud and Abuse: A major reason for waste in the US healthcare spending