A healthcare facility’s health depends on its revenues from reimbursements and out-of-pocket payments from the patients. While payments from patients can be collected with a little ease with a few processes in place, reimbursements from insurance payers are not that easy and they become even more difficult in cases where the claims are denied. A claim denial is one of the most recurring problems encountered by healthcare facilities and it has to be effectively managed to have efficient revenue cycle management. Let us know how problems in denial management can be addressed effectively and facilities’ revenues can be maximized with a few revenue cycle management steps.
- Get familiar: The first thing every healthcare facility and RCM services professionals should learn is that, claim denials are pretty common in the industry for various reasons. Although denials are a part of the healthcare revenue cycle process, appropriate measures should be taken and strategies implemented so as to minimize revenue losses. Facilities should understand where and how they are losing money due to denial, what is the percentage of denials in claims submitted, etc.
- Denial reasons: RCM services providers insist that facilities should identify the reasons that are leading to the claim denials on a regular basis. Mostly denials occur due to false or missing information, delay in filing claims, including services that not covered, filing duplicate claims, etc. Identifying the exact causes of claim denials will help in minimizing the denials.
- Best practices: Denial management should be always done proactively rather than after denials happen. RCM services professionals have to put robust measures in place to avoid denials rather than tackling them later. Healthcare providers or RCM services providers should identify the best practices for claim denial management and ensure that they are being implemented without fail.
- Front-end practices: Claims submission process is not possible without the processes of front-end processes of patient registration, scheduling, healthcare documentation, and medical coding. Denials can happen due to errors at any stage of providing health care and hence, it is always essential to implement strong processes that minimize errors and help in preparing flawless bills for accurate and timely reimbursements.
A healthcare facility’s revenue cycle involves several processes and procedures that need to be performed efficiently so as to improve the facility’s financials and be successful as a healthcare provider. Facilities that are not equipped to tackle medical billing, claims submission, denial management, and other related functions can outsource the process to RCM services providers who have exceptional expertise and experience in dealing with all the processes of a revenue cycle.