What is meant by denial management in medical billing?


Wondering about What is meant by denial management in medical billing? Well, denial management is a term that is used in medical billing to denote the process of handling denials from insurance companies. It may seem like an easy task, but it cannot be very easy for various reasons.

Denial management has become more difficult with HIPAA and other regulations on how health care providers should handle personal information. But the professional medical billing companies know how to deal with it.

What is meant by denial management in medical billing?

Denial Management is the tactic of examining each denial thoroughly, conducting root cause analysis to see why each claim was denied. It also includes analyzing denial trends to identify a pattern by one or more insurance carriers and redesigning or re-engineering the process to lower the chance of future denials.

Thousands of dollars in revenue are lost every year by many physician businesses due to denied healthcare claims. These denials generally originate from a lack of strict denial management rules and processes.

Essentially, you must reduce the number of denials by investigating the source of the problem and the coded cause. Every instance in which no payment or a lesser amount than expected is received must be investigated. This is an important component of optimizing your revenue cycle.

Top Denial Reasons in Medical Billing

Some of the top reasons for denials in medical billing include:

  • Missing or incorrect data
  • Improper or outdated CPT or ICD-10 codes
  • Out-of-network care
  • Duplicate or late submissions
  • Lack of documentation or prior authorization
  • Lack of medical necessity
  • Procedure coding errors
  • Lack of prior authorization

Top Challenges in Medical Billers face in Denial Management

Here are a few of the top challenges that medical billers face in managing insurance denials and rejections.

1- Lack of Staff Appropriately Trained in Denial Management

At the registration desk, some of the first errors in denial management occur. In fact, about 30% to 40% of denied claims are due to registration and pre-service issues. Physician offices, particularly those with smaller staff counts, often have a lot of administrative work to do because they must fill many different roles and deal with frequently changing industry and regulatory rules.

2- Lack of Automation

Managing denials can be automated by using an EHR that is integrated with a practice management system. It allows you to quickly identify the reasons behind your claims being denied, reducing filing times and improving accuracy. Lack of Organizational Accountability for Medical Billing Compliance in Denial Management Processes.

3- No clear directions

Medical billers are not always given clear directions about handling appeals or how often they should follow up on them once filed. Some practices elect not to spend time appealing rejected claims. It is because their staff members feel as though it’s too much work for the little pay-off. This thinking needs to change if you want more revenue from higher reimbursements rates.

Why Choose MDSol Billing to Manage Denials?

MDSol Billing is a leading medical billing company in the USA, and we offer compliant and efficient healthcare denial management services. We help practices get paid accurately for all claims. Our skillful team of experts has the knowledge needed to handle denials while keeping strict adherence to HIPAA regulations at all times.

If you are looking for ways to reduce your number of denied insurance claims or want advice on managing them better, our knowledgeable support staff is always available by phone at 414-786-2372. Get in touch now on LinkedIn and Instagram as well!

Leave a comment

Your email address will not be published. Required fields are marked *

You can call us

or Schedule a free demo to get you started.

Our Services Include