Medical billing is a complex process that requires extreme attention to detail to ensure that revenue is maximized. Denial management remains a significant challenge for healthcare organizations, resulting in delays in payment and revenue loss. However, some steps can be taken to prevent the impact that denials will have on your organization. 

5 Steps to Prevent Denials

1. Sort Denials EfficientlyPhysician happily receiving money

  • Sort by Reason: Categorize denials based on the complexity and time required for resolution. Prioritize those that can be resolved quickly to maximize claim re-adjudication.
  • Sort by Insurance: Organize denials by insurance providers to streamline the submission and follow-up process.
  • Sort by Denial Code: Group denials with similar denial codes for focused resolution efforts. Document the steps that were taken to resolve each type of denial for future reference.

2. Organize Your Workflow

  • Identify the Payer, Claim Value, and Denial Code: Utilize an efficient Practice Management Software to categorize denials based on your desired workflow.
  • Prioritize Worklists: Utilize features such as worklists to manage denials and reduce the number of touches that each claim receives to optimize the incoming revenue.

3. Streamline Front Desk Processes

  • Optimize Patient Intake: Ensure that the front desk is accurately capturing patient insurance information.
  • Utilize Real-Time Verification: Leverage technology for real-time eligibility checks during patient intake to ensure accurate billing information.

4. Analyze Denial Reports

  • Analyze Denial Reports: Regularly review denial reports and business intelligence data to identify trends and the top denial reasons.
  • Implement Workflow Improvements: Use insights from denial analysis to develop strategies for reducing avoidable denials and improving revenue cycle management.

5. Optimize Revenue Recovery

  • Focus on Aged Receivables: Prioritize older denials to expedite revenue recovery and prevent further revenue loss due to timely filing.
  • Patient Analysis: Investigate patient accounts holistically to identify underlying issues that may lead to future denials.

Optimize Your Revenue Today

By implementing a strategic approach, you can transform denials from stumbling blocks into stepping stones toward optimized revenue. With diligence, organization, and the right tools (like OpenPM), you can lead your organization toward a future where denials are minimized and revenue is maximized.