Denials & Complex Claims

Denial Management and Resolution

Managing denials can sap limited medical practice resources and cash flow. Establishing an effective denial prevention program is crucial to the long-term success of your practice. The good news is through preparation, training, and education, practices can effectively mitigate the risk of denials.

By identifying the bottlenecks in processes and technology that prevent clean claims and implementing denial prevention best practices, medical groups can successfully reduce denials and increase revenue. Here are three key areas practices can focus on to reduce the threat of denials.

Pre-service denial prevention should entail:

Confirmation of procedure or reason for visit

Referral information capture

Verification of demographic data at every encounter

Practices should optimize patient registration systems to minimize data risks that could lead to denials. This should include a process for managing duplicate patient records, assignment of required fields as necessary and screening for field format errors.

Third-Party Liability Division

  • Liability cases handled in coordination with our network of affiliated attorneys

  • Identify Third-Party Liability

  • Insurance discovery/third-party billing

  • Settlements resolved sooner with attorney involvement

  • Reduce days in Accounts Receivable

Patient Communication is Key to Success

  • Telephone Campaigns to contact patient in order to gain accident information

  • Customized correspondence to contact the patient in order to gain accident information

Insurance Follow-Up

The key drivers of the revenue cycle for most healthcare practices are the reimbursement of covered services from health insurance payers and co-pays, and insurance deductibles from patients. The more efficient the healthcare provider’s revenue cycle management (RCM) is, the more profitable they will be. Mismanagement of either insurance reimbursements or patient collections can seriously impact a provider’s financial solvency.

Effective claims management depends on the billing staff’s familiarity with the complex and proprietary rules of each insurance company, knowledge of accurate coding, charge capture, remittance processing, timely submissions, and experience with appealing rejected claims.

However, many times low-dollar insurance balances often go untouched. But when the volume is high, these balances can make a significant difference in your bottom line.

RevCare has developed a cost-effective approach to small-dollar insurance accounts that frees up your business office to focus on more complex, higher cash value receivables.

The result makes your daily inventory more manageable and meaningful, and delivers measurable financial improvement:

  • RevCare typically work balances with thresholds up to $5,000 without a clinical denial code -- accounts that had the potential to go untouched before.

  • A combination of dialer strategies, letter series and online capabilities are deployed to resolve accounts, engaging with patients as needed.

  • Regular meetings and reports complete the communication loop.