Denial Management – Need in healthcare industry


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The importance of Denial Management cannot be ignored in a healthcare industry as the absence of it can lead to loss of good amount of collection. Every process of denial management carries a great importance for the medical billing company to increase the healthcare collections.

AccuretRCM recommends implementing Denial Management for carrying out the medical billing process. Some of the advantages of Denial Management are:

It avoids committing mistakes during claim submission

This goal can be achieved with a built-in claim validation procedure which includes payer-specific tests wherein these tests compare every claim with the regulation of Correct Coding Initiative. And diligently it assesses modifiers used for differentiating between procedures on the same claim, and compares the charged amount with allowed amount to avoid undercharging.

Identification of underpayments

The process of identifying the underpayments involves comparison of payment with the allowed amount. It also identifies the zero-paid items, and evaluates the payment timeliness. The effect of this stage can be displayed in a comprehensive underpayment report.

Appeal denials

Appeal management goes through certain stages which include prioritization of appeal, preparation of documentation and arguments, tracking and escalation. Here CCI provides justification basis for an appeal and every appeal must be argued on its own merits, which includes medical notes as well. Denial appeal process is further managed with a custom process tracking system.

Measurement of rate of denial

Measuring the denial rate is important as without measuring it the management will be difficult. It will highlight the modifications required in this process.

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