Accounts receivable & denial management

 Medical billing requires several steps, and the claims determine the practice’s profitability. Claim denials have become a matter of concern over time and can bring a huge negative impact on efficiency and cash flow. When claims are earned and received on time, profits are all that matter, but if they are denied, they can be a major source of loss.

To avoid the flaws, it is very important to bring efficiency and usefulness in the accounts receivable & denial management process to let the practices survive and work with profits. But this leads us to first understand the flaws and the process of eliminating them. Only the elimination can help in effective management.

1. Communication issues

Lack of knowledge is the biggest enemy and brings multiple issues. Irregular follow-ups, multiple calls on the same issue, etc. AR needs deep understanding and solutions that can be:

• Regular training of the team for deep understanding
• Assign callers for the individual purpose to avoid any confusion
• Eliminating gaps in information gathering
• Analyzing data periodically

2. Loopholes in Call Documentation

What you hear can be different from what you are writing. This is called the gap in call documentation. Even a little difference in the patient information and the insurance details can bring hassles. So, what can be done to overcome this problem?

• Call recordings are an efficient way
• Building software to capture the right information
• Call periodically in a consistent flow
• Make a flawless documentation

3. Denials bring more internal friction

It becomes very difficult for the team to manage the denied claims and this cause the burden on the employees that start shifting from one to another. Also, the denied claims take double longer time for approval; one piece of information missing can create a problem. So don’t forget:

• Increasing the insurance complexity
• Off-time claim filing
• Insurance coverage on time
• Complex insurance process

Claim Denial management is imperative and this makes us wrap the blog by saying…

Claim denial is a problem and a blunder in practices; the process sometimes becomes so complex with the staff and timings, thus, managing it becomes mandatory for all healthcare facilities. Automating and streamlining the process can bring flawless working. Outsourcing the denial management process can make the task easy and help in reducing the burden on staff. The time and the energy can be saved and reduce the denied claims. Therefore, an effective denial management process is needed.