Denial Management In Healthcare

Few situations are more frustrating for patients and providers than having seemingly valid claims be denied by insurance companies. For your practice, this could mean your cash flow and revenue may be delayed or disrupted — unless these denials are handled in the proper manner.

This is why Health Revenue 360, LLC provides services for denial management in healthcare. With our expertise, we can offer denial management services that ensure you will be able to collect for every service you perform.

Denied Claims vs. Rejected Claims

Although many use the terms interchangeably, denial management in medical coding is not the same as dealing with rejected claims. A claim that is rejected has not been received or accepted by the insurer, meaning it has not been processed in the same way as a denied claim. Claims that have been rejected may be resubmitted once errors have been corrected, but those claims that have been denied have been determined to be unpayable by the insurance company.

Common situations that could lead to denied claims include:

  • Mishandled referrals or pre-authorizations
  • Incomplete information from patient
  • Duplicate submissions
  • Medical necessity deemed insufficient
  • Not enough documentation provided
  • Treatment not covered under plan
  • Improper credentialing and/or contracting

How We Can Help

At Health Revenue 360, LLC, we offer your practice comprehensive services for denial management in medical billing. Our full suite of medical claim management services includes AR follow-up, claims status checks, resolution of denied claims, preparing appeal letters and more. Because of the complexity of denied claims, many practices lack the time and resources to pursue it as thoroughly as needed. This could have a serious impact on the level of care they provide, as well as their ability to make planned investments in new equipment or staff.

Given the importance of denial management for your revenue cycle, you should have a trustworthy, reliable team to support you through the process. We can take care of this procedure so you can save your time and energy for more important jobs, such as treating your patients. To learn more about how our solution can help, get in touch with us today.

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