Denial Management

Analyse Denials.
Get Faster Payments.
Are you worried about the loss of practice revenue due to claim denials? Claim denials can lower payments by up to 10% and reworking a denied claim could cost more than $100 per claim. Although claim denials are a reality you can't wish away - you can drastically reduce the incidence of claim denials in your medical practice through an active denial management strategy.
What is Denial Management?
Denial management is one of the most vital stages of a healthcare organization's RCM. It is the routine assessment of claim denials to understand the trends and causes. Denial management includes taking corrective action to prevent such claim denials from recurring. The goal of an effective denial management strategy is to ensure that the practice is paid quickly and fully.

Denial management should not be confused with rejection management, which refers to erroneous claims that have not passed the payer's adjudication system and must be resubmitted. A rejected claim is much more likely to be paid when resubmitted than a denied claim.

Critical Components of Effective Denial Management
Denial management involves taking a holistic look at the practice's denials, identifying trends, and taking corrective action in claims submission. Performing all three steps is essential for enhancing the efficiency of claims submission while drastically reducing the revenue lost in claim denials.
An effective denial management strategy must include these three critical elements:

  • All payments received from the payers and patients are posted in the practice medical billing system
  • We process paper checks as well as electronic remittances
  • Daily reconciliation of payments received and posted in the medical billing software to ensure no charge is missed or incorrectly posted
  • Timely redirect denied claims to secondary payers so that patients only pay for what is due from them
  • Payment posting is processed per your specific guidelines, including write-offs and refund rules
  • Regular denial analysis to identify non-payment issues and take corrective steps to reduce denials in the future.

Elite’s Denial Management Services
Denial management must be ongoing, which is why most healthcare enterprises prefer to outsource this function. Working with an experienced denial management service provider like Elite boosts revenues and gives practice staff the time to concentrate on core responsibilities.

Here is how outsourcing denial management to Elite Offshore will benefit your medical practice -

  • Proactive tracking and resolution of claims.
  • Automation of the denial management process using the latest software.
  • Create system alerts to ensure that claims do not age.
  • Comprehensive claim denials analysis to lower accounts receivables (A/R).
  • Examine the causes of claim denials.
  • Resubmit denied claims and file appeals where required.
  • Regular reporting of claim denial trends to plug problems that are practice specific

Elite Offshore clients experience a minimum lowering of days in A/R by 10 to 15% and improved revenue collections by at least 5-6%. So, if you want to take your denial management strategy to the next level, please fill the form below.

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