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 system 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 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
Service Highlights
Benefits
Revenue Cycle Management
Are you a healthcare provider under increased pressure to focus on providing care as well as maintaining financial viability? Do you feel overwhelmed with administrative and financial responsibilities? Feel like you are losing pace on follow-ups for efficient collection? Are you short of trained experts to handle the complex maze of RCM? Scribe4Me is here to help you.
Insurance Eligibility Verification
The first and most important step is to determine the patient's eligibility and insurance coverage. People often tend to forget to renew their health insurance policy annually. And insurance companies are in no way responsible for payments covered under the plan during the period of lapse. As a result the patient has to pay for the services out of his own pocket. What if the patient is reluctant to pay the bills?
Medical Coding
Medical Coding quality holds the key to accurate reimbursements. Scribe4Me has perfected the art of creating accurate and clean claims on the first go. We have a team of AAPC certified, trained medical coders who are proficient in coding rules and can provide accurate and complete coding necessary to optimize reimbursements.
Charge Entry Services
Accurate charges are crucial for claims to pass through the first time and Scribe4Me does it right, each time.It has been stated by insurance companies that 4 out of 10 claim denials are due to clerical errors. Charge Entry is a process of entering medical data to enable claims processing. At Scribe4Me we follow a well-structured Charge Entry Process and ensure that relevant checks are made at each level of the process.
Claims Transmission
Scribe4Me undertakes to do an EDI set-up for those medical practices that wish to get-off paper transaction claims and switch to electronic data interchange (EDI) for claim submission. Submission of the claims through EDI reduces the chances of inaccuracies and errors. Your claims will reach the payer instantly resulting in quicker reimbursements and eliminating claim processing delays.
Payment Posting
We believe that accurate charges contribute to attaining clean submission goals. Scribe4Me offers fast and accurate Payment Posting solutions as a part of the Revenue Cycle Management services and also as a standalone service depending on the client's requirements. Our team of experts has extensive experience in several specialties and in handling a wide range of medical software.
Accounts Receivable Management
We at Scribe4Me understand that Accounts Receivable is an important part of cash flow and requires rigorous follow up. That is why we have a streamlined system in place to control and manage your practice's accounts receivable and recovery. Simply trust the experts for efficiency, and we assure you that all the medical services provided by you will be paid for, fully and promptly.
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