MedCross RCM

The Risks of Not Having Denial Management Process

• Accounts receivable backlogs

• Increase cost to collect

• Stagnant cash flow

• Increasing write-offs

• Revenue lost

• Poor patient and physician satisfaction

How We Can Help You

Due to lack of expertise and time, a good number of private practice and even hospitals have no denial management in place, which results in thousands of dollars in lost revenue.

As part of our medical billing services, we have included denial management to prevent sizeable revenue leakage. We have a dedicated team of employees who manage and resubmit denied claims, and analyze data and trends to prevent this from happening in the first place.

Filing Appeals or Resubmission

We analyze the reasons for denial so we can make an appeal letter and resubmit the claim together with additional clinical documentation. We follow the payer-specific format to increase the chance of approval.

Missing and incorrect information is one of the most common reasons for denial. This includes even the most basic information such as the social security number, patient address, plan codes, modifiers, among other things.

In fact, it has been estimated that up to 60 percent of claim denials are caused by missing information.

We Do Real-Time Analytics Reports

We conduct data analytics to identify the root causes of the claim denials. In some cases, the problem stems from coding, care delivery, patient scheduling and access, clinical documentation, patient payment expectation, lack of collaboration between stakeholders, etc. Once we identify the fundamental reasons for the occurrence of a problem, we can come up with solutions.

We Monitor Payer Policy Changes

We stay current with any changes in the health insurer policies, which affect every stakeholder such as the private practice, the hospital department, and ultimately the revenue cycle.