Denials and Appeals Management Services at HIS

At HIS, our goal is to help medical practices increase cash flow and profitability through high-quality, personalized RCM services. With more than 30 years of industry experience, we are proud of the rigorous denial and appeal management for clients across the United States. We perform a detailed review of each denial and take appropriate action in 24 hours. Our detailed process identifies the root causes of the denial making the appropriate corrections to turn the denial around for appeal and payment. HIS team tracks, trends, and identifies critical areas of concern to provide for a foundation to improve or eliminate avoidable denials caused by front-end process errors. Our RCM experts then provide recommendations and feedback to your practice to improve documentation, coding, and front-end processes to reduce the claim denial rate.

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What is Denials and Appeals Management?

Healthcare denials and appeals management is the cumulative work completed by administrative, clinical, coding, and revenue cycle professionals. Denials have always put a strain on providers’ time and resources, which makes it a crucial aspect of your revenue cycle management (RCM). According to a study by Waystar in 2019, 67% of providers say that denials are their biggest RCM challenge. The goal of healthcare denials and appeals management is to prevent inappropriate denials from occurring by informing and assisting the front-end revenue cycle, clinical, and coding processes.

Maximize Your Denials & Appeals Services with Our Other RCM Services

HIS is committed to being your trusted partner for revenue cycle management. Get access to our full suite of services, from value-based reimbursements to medical billing services.

Looking to improve your denial management workflow? Schedule a consultation today.

How Denials and Appeals Management Works

The first step in addressing denials is to identify where in the revenue cycle they are occurring and why, so you can know how to prevent them. Here are a few common hidden causes of denials:

  • A patient lacks coverage for a given procedure or treatment
  • A patient may not be properly be enrolled
  • Insufficient documentation explaining the need for a medical procedure
  • Demographic data errors
  • A lack of pre-certification

Sometimes a denied claim can be appealed, however, it should be submitted to the insurer in a timely manner. At Healthcare Information Services (HIS), our team will review the insurance company’s rationale for denial and provide a thorough list of reasons why we disagree, backed by supporting evidence. Then, we will continue to monitor for updates to determine whether it has been overturned. 

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Benefits of Outsourced Denials and Appeals Management

When you choose to work with HIS, you are partnering with a firm that has the capability to handle high volumes of denials and help address lost revenue. There are several benefits of outsourcing your denials and appeals management, including:

  • Identify and correct causes of denials to improve your clean-claims rate (CCR)
  • Reduce your administrative costs
  • Resolve underpayments by leveraging our expertise
  • Streamline workflows for greater efficiency, faster appeals, and improved cash flow
  • Reduce regulatory risk with increased compliance
  • Improve RCM and financial performance

Minimize Denials with HIS

Denied claims are preventable if handled properly and early in the process. At HIS, our RCM solutions are tailored to the individual provider’s resources, workflows, and teams and allow you to focus on what’s most important — caring for patients. Contact us today for information about our services or to schedule a consultation with a member of our team. We look forward to hearing from you!