Denial Management

HANA HealthCare Solutions is committed to reducing lost reimbursements and claim denials through the implementation of highly effective systems and services tailored to the specific needs of our clients. A significant challenge encountered by healthcare providers and medical billing companies is the substantial number of denied claims that remain unaddressed and are not resubmitted. HANA HealthCare’s Denial Management process in medical billing identifies and rectifies the underlying issues that lead to denials, thereby expediting the accounts receivable cycle. The denial management team analyzes the correlation between individual payer codes and prevalent denial reason codes. This analysis aids in identifying weaknesses in the billing, registration, and medical coding processes, which are subsequently addressed to minimize future denials, ensuring that claims are accepted upon first submission. Additionally, payment trends from various payers are scrutinized to establish a system that alerts stakeholders when deviations from standard patterns occur.

For claims that have been denied and require an appeal, our team prepares appeal letters accompanied by supporting documentation, including medical records, for processing. If the insurance provider allows for telephonic or fax appeals, we also manage those communications through the appropriate channels.

Strategy for Reducing Denials Below 3%
To establish a strategy aimed at reducing denials to below 3%, it is essential to concentrate on several critical components:

• Preventive Actions: The implementation of preventive actions can greatly diminish the incidence of denials. This encompasses verifying patient eligibility, securing pre-authorizations, and ensuring precise data entry.
• Denial Oversight: Form a specialized team dedicated to managing denials. This team should be tasked with tracking, analyzing, and appealing denials effectively.
• Staff Education: Provide regular training for your personnel on the most current billing practices and regulations. This initiative can help minimize errors that contribute to denials.
• Technological Integration: Utilize technology to automate the billing process and mitigate human error. This may involve the use of electronic health record (EHR) systems, billing software, and denial management solutions.
• Routine Audits: Perform regular audits to uncover the underlying causes of denials and implement necessary corrective measures.
• Patient Engagement: Enhance communication with patients regarding their financial obligations. This can aid in preventing denials stemming from coverage issues or non-payment.

It is important to note that the objective is not merely to manage denials but to proactively prevent them. By prioritizing these areas, you can significantly lower your denial rate and enhance your revenue cycle management.