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Medical Claims Denial Management

What Is Medical Claims Denial Management?

medical claims deniedMedical claim denials and the medical billing staff handling the claim denials can be the difference between average and outstanding collection rates. The basic philosophy at WorkSmart MD Billing is "pro-active" versus "re-active."

The majority of medical billers are already overwhelmed by an endless number of claims management and medical billing tasks. The most common process is insurance payments arrive and the medical biller posts these payments. Insurance claim denials are often flagged and put to the side to come back to at the end of the week or, even later. The problem is that most commonly these denials never get worked and the money ends up building up in your accounts receivable. This is an all too familiar tale. Some claim denials are easy to fix but often times they are complicated. It's very difficult for physician offices to incentivize their employees to scrutinize these denials. Understanding that many, even most, claim denials can be reversed is critical. Rather than letting a claim denial sit it should be reviewed and worked at the time of posting.

How To Avoid Common Errors

  1. Once payments are posted start with your first denial. Review the denial code and see what it translates to. Never be afraid to ask someone. Use an online forum if necessary.
  2. Is the denial is related to timely filing be sure to check your clearinghouse reports to see when it was first submitted. Many times these timely filing denials can be overturned with proper documentation.
  3. If there was a diagnosis code or procedure code error consult your EMR software system to verify the service provided.
  4. Many claims can be reprocessed and modified over the telephone. Don't be afraid to pick it up, it will pay dividends. Always be sure to document who you spoke with, their extension, and a reference number if available.

medical claim approvalAt WorkSmart MD Billing our medical billing experts are trained and required to work insurance denials as they post insurance payments. This ensures they are never overlooked. Our web-based medical billing software communicates directly with each insurance company and allows us to correct denials before the paper EOB comes in the mail. Our web-based EMR software, in conjunction with our industry leading billing experts, allows us to demonstrate collection rates of 97% plus! While there are many firms that offer medical billing services,  WorkSmart MD Billing stands out as the clear leader.

We Can Turn Denials Into Approvals

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