Denial Management Services

Expert assistance in handling Denial Management

It is an undeniable fact that claim denials continue to be a thorn in the flesh for many healthcare providers. It has been rightly said “If you can't measure it, you can't manage it”. This holds true for claims denials too. Without a strong denial management system in place dealing with claims denials can be frustrating and time consuming. Scribe4Me’s Denial Management service is designed to perform a root cause analysis and take necessary action to resolve it. But that’s not all. It also includes reducing the risk of future denials, ensuring that you get paid faster and enjoy a steady cash flow.

Scribe4Me has established a solid healthcare denial management system and this is how it works:

Identify

As a first step we undertake to identify the root cause and determine the reason for the denial. When the insurance provider denies a claim they indicate the reason referred to as Claim Adjustment Reason Codes (CARC). Unfortunately, interpreting these codes takes time and requires expertise, since some insurance providers continue to use the overly complex, legacy codes. But our dedicated denial management professionals can easily handle these codes and identify why a claim was denied and who is responsible for its reimbursement.

Manage

Once the reason has been identified we take the steps necessary to resolve it. For this purpose we route the claims directly to the concerned department for them to quickly and efficiently act on each item. Our team follows a streamlined approach to sort and analyze denials by amount, time, reason, among other factors. This helps us to identify the categories that have the greatest denials and restructure processes and implement quality control measures to stop denials at its tracks. Once the reasons for denials have been categorized we assign it to the respective team to take corrective action.

Resubmit

Most of the claims denied are recoverable. All it takes is to rework the claim, ensure it is correct, and resubmit it. So, once the reasons for denials have been identified and categorized, we resubmit the claim. After making the necessary corrections and addressing the issues that led to the denial in the first place, claims are resubmitted for payment without any further delay. As the odds of reversing a denial are good, this is a crucial step to increasing revenue rather than losing money that may be rightly owed to your practice.

Monitor

We believe that denial management is an on-going process that needs to be continually monitored to keep track of everything and ensure that claims get successfully paid this time around. For this purpose we keep track of denials by type of denial, date received, date appealed, and resolution. Then we audit the denial management team’s work by selecting a sample of their appeals and finally make sure that they are equipped with the tools and technology to get their job done.

Prevent

With all the relevant data regarding denials in hand we setup a prevention campaign. We look for opportunities, to revise existing processes, modify existing workflows or retrain our staff. Together with it, we also

• Set up a multidisciplinary team to analyze denial reasons, study trends and discuss which categories to address first
• Set up regular meetings with the multidisciplinary team to focus on a particular denial category
• Follow-up on the effectiveness and adequacy of the internal controls in managing and preventing healthcare denials

Our Service Highlights

• HIPAA compliant tools and technologies to track and follow-up on submitted claims
• Team with extensive knowledge of payer-specific guidelines
• Denied claims analyzed for reasons with power of appeal
• Root cause analysis of denial trends by payers
• Tackle claims denial causes from the front end to reduce denials
• Proactively prevent future denials with our best practices

Benefits of Scribe4Me’s Denial Management Services

• Improved clean claim rates
• Strict adherence to HIPAA regulations and their compliance
• Denial management experts hand-picked for their expertise and experience in the domain
• Regular training for the team to sharpen their skills and keep them updated with the latest payer-specific guidelines
• Keep the initial denial rate below 4% (industry average is 5% to 10%)
• High-quality services at cost-effective rates
• Fast turnaround times
• 40% reduction in operating costs
• State-of-the-art infrastructure, cutting-edge tools, and technologies that are at par or above industry standards

Outsource Denial Management Services to Scribe4Me

As your trusted denial management partner Scribe4Me aims to reduce denial rates over time and help your practice thrive. With Scribe4Me you gain access to a large pool of denial management specialists who have experience in dealing with a wide range of denial scenarios and can leverage their expertise to resolve issues quickly. We help identify the root cause, prevent future denials, get paid faster and enjoy a healthy cash flow. Uncover strategies for successful denial management with Scribe4Me - Enhance your financial stability and improve operational efficiency. Sounds appealing? To learn more about our denial management services and how our team at Scribe4Me can boost your revenue cycle and financial success get in touch with us today.