4 Steps To A Better Denial Management Process

No one likes to be denied, but the important thing is how you manage to triumph over denial effectively. No matter what line of work you’re in, being able to deal with rejection is something everyone needs to know how to do to function professionally and personally. The steps you take to get through this difficult process will play an essential role in how your future clients react to your product or service, so it’s best to be prepared. This article outlines some of the best denial management processes you can take to better manage the denial process to leave a lasting and positive impression on both you and your customers or clients.

Categorize and Provide Direct Access to Reports

It is useful to have a specific report or document available for new business in some cases. This helps with faster responses to those claims and provides consistency for other employees who are responding to that denial management process. Sometimes you may also have multiple tiers of people who will respond to these reports/docs. In these instances, a reporting tree should be established and processes around accessing and distributing those documents to your various levels of administration and insurance personnel. You can use these categorizations in the CMS (Content Management System) on your digital case portal or database if you have one.

Create an Incentive Program

This can be a tough sell, but you must begin with a thorough review of your current system. Before an incentive program can work, you have to make sure your staff is able to identify denials they may not have caught previously. Once you’ve created an incentive program, provide monthly scorecards and feedback to help your team improve in specific areas. And don’t give up if at first one doesn’t take hold—the key is to make it clear that your ultimate goal is to prevent denials from happening to keep member satisfaction high and payment rates on track.

Automated Insurance Verification

One of the most important steps to a better denial management process is automated insurance verification. The goal is to help you meet your goals for managing health care claims in a way that helps you reduce fraud and increase your overall savings. But, what does automated insurance verification mean? Consider these points as you think about how it may apply to your organization:

1) Every claim received from an enrolled member must be matched against all carriers they have selected at checkout or during enrollment.

2) A business user can create custom rules using pre-defined functions that are then included within required fields on forms and reports. Automated rules will trigger information requests based on thresholds defined by an administrator or business user.

Outsource Your Denial Management Services

Outsourcing your denial management services can be an excellent solution for large medical practices with high volume and denial management issues. Insurance companies often make mistakes in submitting or paying claims, so it is essential to have an outside company help monitor these discrepancies. The best way to handle errors is not to let them happen, which is why outsourcing is effective. Using outside companies to take care of your insurance claim submissions and payments will save valuable staff time and resources. This frees up time for employees to concentrate on more important matters such as patient care instead of worrying about submitting another appeal on a denied claim.