According to a survey conducted by Harmony Healthcare, there has been a 20% increase in claim denial rates over the past five years. With the global takeover of the COVID-19 pandemic, this issue has only worsened, and the figures are at an all-time high. To the financial strength of any medical practice, this could be devastating as this means unpaid or delayed revenue. However, this could be completely avoidable if healthcare providers took the time to understand how denial management works and what they could do to increase their first-pass claims submission rate.
Denial management is the thorough and systematic process of analyzing every claim denial to determine the reasons behind why it was rejected. This procedure aims to discover a common pattern among all the claims denial through establishing a connection between payer codes (individual payer patterns) and denial reason codes. By understanding this relationship, the billing team will subsequently be able to improve their medical billing processes to increase their first-pass claims submission rate, increasing their overall revenue and cash flow.
The IMMP (Identify, Manage, Monitor, and Prevent) approach is one effective field-tested technique that healthcare providers use in managing claims denial. This process helps the billing team to understand the root source, reason, cause, and contributing factors to the rejection while developing management strategies to lower the risk of revenue loss.
By resolving all your claims denial cases timely, you would be able to reduce the likelihood of unpaid services that could result in a revenue loss, which could significantly impact your practice’s financial strength. In addition, this process is critical in analyzing the common trends and root causes that lead to claims denial, helping you develop a management plan to respond to future cases, and collecting relevant data and information to support your appeal.
With our founder Kayla Ruiz having more than two decades of experience in the medical billing industry, we understand the importance of timely denial management and can help you develop a strategic plan to manage these cases. While healthcare providers should aim to reduce their margin of error regarding claims submission, claim denials inevitably happen from time to time, especially during highly stressful periods. That is why we are here for you to offer our services and lend you our support every step of the way.