Improve Revenue Cycle Through Our Denial Management Services

Medical billing and denial management services is the process of examining, evaluating, addressing, and avoiding insurance claims for medical services. These are provided by a psychiatrist or any other competent professional in the field of healthcare. Moreover, people tend to confuse denial management with rejection management. The following claims were never processed, analyzed, and rejected by the payer’s adjudication system as a result of errors.

At MAVA Care, our medical billers edit these claims and send them back for healthcare denial management. There are three types of claims: submitted claims, pending claims, and denied claims, which refer to those claims that have been considered and rejected by the payer. To appeal refused claims, our billers need to investigate the appeal’s underlying cause, pursue corrective approaches, and file the appeal to the payer. To advance, common concerns with the front-end processes must be solved continually to prevent denials from recurring.

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We Clear All Major Denials in Medical Billing

Insufficient Insurance Coverage

One of the most common reasons for medical billing denials is because the patient’s insurance coverage has expired, been discontinued, or has not been established. Our skilled medical team can help reduce such denials by checking insurance eligibility and coverage before the patient’s visit, ensuring current and precise data is gathered.

Inaccurate Patient Information

Claims may be denied due to errors in patient demographics, such as inaccurate name spelling, date of birth, or contact information. For effective healthcare denial management, we have comprehensive patient registration and verification processes, which include regular audits.

Invalid Information

Missing or insufficient documentation is also a common cause of claim denial. Insufficient or incorrect information. We employ an EHR (electronic health record) coded and claim scrubbing technologies to discover and correct such errors before filing claims.

Coding Errors

Medical coding errors, such as inaccurate diagnostic codes, procedure codes, or modifiers, can result in claim denials. We give frequent training and instruction to coding professionals and internal audits to assist us in detecting and remedying coding problems and reducing denials.

Duplicate Billing

Submitting several claims for the same treatment or procedure is a common refusal reason. It frequently arises when billing systems or procedures fail to flag or identify duplicate claims before submission effectively. So, we build automated claim review processes and use technology to detect duplicate claims to avoid such denials.

Referral Issues

Denials for lack of prior authorization or referral paperwork are common in medical billing. We build effective communication channels with payers, educate personnel about authorization needs, and put in place solid systems to quickly get and document essential authorizations.

Our Denial Management Procedure

Appeal Preparation

We use preventive steps to avoid the time-consuming and costly process of claim denial management in healthcare, which is a much more efficient way to increase reimbursements. We identify and categorize the most prevalent reasons for denial and can refer them to the appropriate departments. 

Categorize Denials

Once denials and rejections are detected, we categorize the practice and perform healthcare denial management according to the causes. Common categories include coding errors, duplicate claims, a lack of medical necessity, and patient eligibility concerns.

Root Cause Analysis

Our investigation procedure includes identifying the error or mistake in the medical billing system that resulted in the initial claim denial. After determining the main cause of the problem, we correct the errors throughout the procedure, effectively appealing the claim denial.

Appeal Submission

If the denials specialist or biller does not agree with a coverage or payment determination, they file an appeal. If the claim was properly submitted, the insurance company should have compensated the provider based on the payer’s EOB. When a claim error occurs on the provider’s end, they can rectify and resubmit it.

Implement Corrective Actions

To avoid similar scenarios in the future and deal with systematic problems, we modify internal staff performance, particularly the aspects of coding as well as documentation. Our solutions to suboptimal documentation consist in guaranteeing that every record is complete, correct, and compliant with the payers’ standards. 

Monitoring and Preservation

Our team effectively monitors and prevents denials. Our team of denials management services gather information to prevent future denials and rejections. We will work with the provider to improve documentation or adopt better patient eligibility verification methods at the front desk.

Prevent Denial Through Effective Billing

How We Prevent Denial Through Effective Billing

We implement preventive efforts to avoid the time-consuming and expensive process of claiming. Denial management services are a significantly effective way to increase your reimbursements. Our rejection management staff analyzes and categorizes the most prevalent refusal causes, directing them to the appropriate departments.
The preventative steps include:

  • Training front-office workers for appropriate coding and billing
  • Maintain correct patient details and medical data
  • Promptly filing claims
  • Stay up to date on insurance claim procedure changes
  • Employing an electronic medical record system for quick access to data
  • Confirm insurance and eligibility before giving services
  • Frequently monitor and analyze revenue and denial rates

We Manage Claim Denials in Medical Billing

Focus on Claim Resolution

We prioritize resolving denied claims by identifying the root causes and implementing corrective actions to ensure accurate and timely reimbursement.

Reporting and Feedback

Provide regular reports and feedback to healthcare providers on the status of claims and improvement areas, helping streamline the billing process.

Check the Status of Claim Submission

Regularly monitor the status of submitted claims to ensure they are processed efficiently and address any issues promptly to prevent denials.

Patient Communication

Assist in communicating with patients regarding their claims, helping them understand their benefits and any actions needed to resolve issues.

Denial Management Services for Hospitals

Hospital denial management services relate to identifying, studying, and managing denied cases by insurance providers. These services include detailed work-up of denials based on causes like coding, documentation, or possible policy-related elements. Effective healthcare denial management reduces the number of claims denied, leads to early reimbursement, and, thus, is a key to making the hospital’s revenue cycle efficient. These activities comprise staff training, performance assessment through audits, and technology implementation in managing complaints. Denial management services improve the hospital’s financial status and overall operational efficiency.

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