With the already lengthy medical billing process. All a providers want is a proper denial claims management. With higher demand of the physician , organization are more focused on services. Organizations are more focused on highly skilled efficient worked than in operational extension
In any health care organization claim denials plays a vital part. Any hospital reputation depends on the satisfaction of the patients, which includes effective service with proper care facilities. Smooth Claim management without denial claims.
Nowadays denial claims to be part of the regular process in hospitals. The average percentage of claim denial rate for the industry is between 5 percent and 10 percent, according to a report of American Academy of Family Physicians (AAFP). Providers should aim to keep their claim denial rate around 5 percent to ensure their organization is maximizing claim reimbursement revenue. As stated in march 2017.
At times these claims can be controlled but there are few steps in which focus needed to be given in order to reduce the denial claims rate.
The errors for error can be:
Administrative error
- Incomplete claims information
- Failure to obtain preauthorization
Documentation error
- Procedure and diagnosed codes indirectly linked
- Multiple codes submitted for single services
Coding error
- Benefit not covered
- Service not medically necessary
- Terminated insurance etc
Reasons can be many but our focus is on reducing this denial error. As any denial is not in our hand. but we can surely reduce it with a little more careful effort and prevention taken from our end. As in this claim denial process, it not only trouble the person concern but also eats up our time and money for the people detailing it
Here are a few steps where attention has to be given:
- Pre denial management
Software can be used to check and reduce errors during the transmission and processing of claims. Using proper dedicated organized team for claims management focusing on the reason for most of the claim denial also helps and reduces the denial rate. As then the organization knows the areas to focus on and so can work on it in a more efficient way.
- Post denial management
Tracking and keeping records on the denials claims and recovering it as soon as possible. Will be benefitted to any organization revenue cycle. Aso focusing on the reasons for denial trends and working accordingly also helps. In fact, most organization outsource their denial management process for their own benefit. As it’s more cost effective for any organization.
Why Sunknowledge ?
We at Sunknowledge with our 12 years of service to US healthcare in claims adjudication for a few major US major insurance plans. has a record on reduction receivable accounts by 30 %. With $7 per hour, our accounts receivable cost starts from 2.5% of collections. Sunknowledge gives equal attention to all cash amounts regardless of its size and sources. We also have dedicated people like account manager and team leader with no charges being one of our specialties. For better services from our end. And also exclusive customized report
If this all interests you all then. Then please do visit our website for more information so that you can effectively rending our services.
