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Denial Management

ClaimDenial

Striking on denied claims in advance, before they occur, is the goal. This allows providers  the opportunity to reduce at that 90%. While there are plenty of ways to reduce this number but following are three important tactics to start with:

·       Patient eligibility must be strictly monitored and should remain on top of check-list, perhaps in the number one spot. Verifying patient eligibility beforehand ensures that patients have insurance to cover the treatment.

·       The claim itself must be clean: procedure codes, which gets updated from time to time, must remain up-to-date. To track down those changes is difficult task and time consuming, but an automated solution can do this all heavy lifting to keep the codes updated.

·       Some claim will still be denied, regardless of how much effort is spent verifying eligibility and checking claims. But to some extent this approach has a positive outcome: Common reasons for denial will be identified and an automated defined workflow per carrier policy will be deployed which will help prevent them in the future ensure office staff understand the reasons behind denials.

Once this portion of the revenue cycle management is automated, process can provide exceptional value to providers as the process also impacts the over 50%  of denied claims that are never re-filed to carriers. By analyzing current and historical denials to ensure the practice receive all the revenue it deserves, which drive collection to get on the right side on 90%.

OMB provides fully automated PMS/EMR/EHR and EDI solutions to mitigate billing and coding related denials to improve first pass and clean claim rate in order to improve your collection.

If you have any such requirement, feel free to get in touch with us and we will contact you within 24 hours.

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