Medical Billing Denial Management Process: Why It’s Necessary

Billing & Reimbursement

Denial Management Denial management will always be a necessary part of the medical billing process. At HIS, we are constantly working to minimize the time and efforts associated with denied claims. Our investment in new technology, automation and tying them to improved processes is allowing this goal to be achieved.

Electronic Edits to Flag Potential Problems

We employ electronic edits to flag potential problems early and use scrubbers for improved “clean claims”. The result of these practices contribute to HIS having more than 95% of claims submissions paid by insurers on the first pass.

When Medical Claims are Denied

When a claim is denied. HIS employs a very thorough and detailed strategy to address those claims and get the resubmitted efficiently and accurately.

A tried and true process: All denied claims are individually addressed by the HIS Denial Team or a Coder. An aggressive denial claims tracking system ensures that each denial is reviewed and responded to within the timeframe of specific payers. Should an appeal be necessary, the Denial Team will ensure that the appropriate parties are contacted (hospital, coder, or physician) and that letters are submitted in a timely fashion.

HIS staff maintains access to partner hospitals’ electronic information systems in order to obtain necessary documentation for successful denial and appeal replies. Denial information is tracked and trended for purposes of informing process improvement projects, both internally and at client facilities. Trended denial data also helps identify opportunities for educational initiatives with physicians and coders.

Medical Claims Denial Prevention

At HIS, we not only focus on current claims but we work hard to minimize future denials through this intelligence gathering and process improvement. HIS is dedicated to excellence and to providing top notch service to our partnering physicians. A partnership with HIS is a lasting one that provides great value beyond just the ROI.

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