Taking An Active Role In Claims Denial Management

Claims denial is part of any insurance revenue cycle, particularly when it comes to healthcare. While it is unrealistic to assume claim denials will drop to 0%, there are ways to prevent it from happening. According to the American Medical Association (AMA), denial rates ranged from 0.54% to 2.64% for major private payers and up to 5% for Medicare. Rates are down across the board from 2012, but there is still room for improvement.

The cost of claims denials has prompted some providers to focus on avoiding denials in the first place. The process involves:

• Putting an automated procedure in place
• Identifying and evaluating reasons for denials
• Enhancing front-end processes for the revenue management cycle
• Handling denials using an expedient method

The vast majority of denials are avoidable. By identifying the most prevalent reasons for denials, providers can improve their processes to reduce these issues. Some of the most common causes for denial include:

• Payer does not cover services
• Claim submitted outside of time limit
• Duplicate claim submission
• Relevant information missing

Rather than waiting for a rejection notice, providers can take an active role in claims denial management. By reducing inefficiencies that cause or promote common errors, providers can save money by avoiding denials. The best way to achieve this is with a custom in-house solution to address your specific claims process. Contact Actec to learn more.