• Practice Solutions

3 Signs That Signal You Need a New Denial Management System


Main Points

  • You need a new system to manage denials if you do not have the ability to see denial trends

  • You need a new system to manage denials if you can't see a root case of the denials

  • You need a new system to manage denials if you can't see what each member of your administrative team is doing to fix the issues

Denials are an assumed part of running a private practice. Therefore, you have to build a system of managing your denials and tracking how they are being worked. There are some clear signs that you need to either build out a new system or rework your current system to give you full visibility into your claim denials. Consider this, the American Medical Association believes that between 1-5% of all claims submitted in the US are denied on the first submission.

Over the life of your practice that could equal quite a few denials. If you are worried that you might need a new denial management system, then take a look at these indicators, and you will know for certain.

You need a new system to manage denials if you do not have the ability to see denial trends. This is a clear reason why you need a new denial management system for your practice. Since denials are an assumed part of running a practice, you will need to see what the main denial reasons are and why they are occurring. Here are some top denial reasons that may show up on your report:

  • Patient not active with this insurance plan

  • Duplicate claim re-submission

  • Provider not an approved provider

  • Coordination of benefits issue

Each of these reasons has a clear solution that may actually be a small process change. However, you won't know what or who to change if you are not aware of the trending of your denials.

You need a new system to manage denials if you can't see a root case of the denials. This goes along with seeing the trending data, but you will also need to know why the errors are occurring in the first place.

Are your providers credentialed correctly? Are your VOBs done in a timely manner and appropriately communicated to the patient? Are your patients staying up to date on their insurance coordination?

If you are not able to pinpoint exactly what the root cause of the denials, you won't be able to solve the denials long term and your practice will continue to expend time and money to solve denials and denial trends.

You need a new system to manage denials if you can't see what each member of your administrative team is doing to fix the issues. Transparency in healthcare, especially, the business of healthcare is a big deal. Not only does transparency help you determine your staffing resources, but it also assures patients that their claims are getting worked on in a compliant manner.

You want to build a practice that offers as potent of services as possible, and one way to do that is build in accountability into the staff.

Methods of doing this include; having shared spreadsheets or even regular reporting to the team on the goings-on of the billing activities.

Having a method where you can see what each member of the team is doing to assist on denials can also help when explaining denials to patients.

Managing denials is a multi-variable task that requires a fair amount of monitoring and maintaining. If you want to automate this process or want to talk through how to get the most out of your team feel free to call us at 734-437-9432 and we are happy to talk through how you can get the most out of your denial management process.

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