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Healthcare administrator managing denial management processes in an office setting.

Denial Management

Our team of specialists employs a streamlined approach to monitor and recover outstanding accounts receivable, meticulously overseeing each individual claim.

What Is Denial Management In Medical Billing?

Distinguishing between denial management and rejection management is crucial in medical billing. Rejected claims are those not yet processed due to errors, requiring correction and resubmission. Conversely, denied claims have been processed but lack payment approval.

It’s essential for healthcare organizations to prioritize both rejected and denied claims. Rejection management identifies and rectifies claim issues, while denied claims pose potential revenue loss if paid post-appeals.

Billers must conduct root-cause analyses for successful appeals, addressing underlying issues. Continuous improvement in front-end processes is vital for preventing future denials and maintaining financial stability in healthcare organizations.

Medical Billing

Denial Management Solutions

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Claim Resolution Focus

We prioritize resolving claims over merely gathering status information, channeling our efforts towards rectifying issues and achieving successful resolutions.

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Workflow Automation

We integrate customized web-based systems for individual claim status codes. These systems prompt insurance companies with pertinent questions to address claim issues, ultimately enhancing the quality of documentation.

Healthcare administrator managing denial management processes in an office setting.

Claim Status Checking

By boosting the utilization of web portals, we streamline the process of checking claim statuses, providing automated and convenient online access to this information.

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A/R Reduction

Our advantages encompass a minimum 20% decrease in A/R days and a roughly 5-7% boost in collections. Through optimizing these areas, we guarantee enhanced financial results.

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Comprehensive Dashboards

We create comprehensive reports with multiple variables to enhance our comprehension of accounts receivable (A/R). These reports offer valuable insights, empowering us to concentrate on efficient resolution strategies.

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Regulatory Compliance

We assist healthcare organizations in adhering to evolving healthcare regulations and payer requirements by staying current with coding guidelines and billing regulations.

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