Denial Analysis and Resolutions

The formal definition of denial is, ‘the refusal of an insurance company or carrier to honor a request by an individual (or his or her provider) to pay for healthcare services obtained from a healthcare professional.’ Every medical practice experiences claim denials. Better performing practices have denial rates below 5%; other practices are seeing claims being denied 10%, 20% or in the extreme 30% of the time.
Denials are an epidemic to the financial health of most practices, and they have a need to be treated well in order to get you financial success. 10% of the physician revenue is estimated to be lost due to lack of denial management process. A good approach is to understand the different types of medical billing denials, pinpoint the most common billing problems and take steps to avoid them.
We have a denial management team who fix the issue and send the claim for reprocessing. They establish a trend between individual payer codes and common denial reason codes. This trend tracking helps to reveal billing, registration and medical coding process weaknesses that are then corrected to reduce future denials, thus ensuring first submission acceptance of claims. Also, the payment patterns from various payers are analyzed for setting up a mechanism to alert when a deviation from the normal trend is seen.

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