Health insurance claim denials can be very costly and time consuming. When a claim is denied, the consumer has the opportunity to appeal the decision. Healthcare organizations must have processes in place to provide both internal and external appeals processes. The expenses and the time required to process them can be reduced and possibly even eliminated. So,how do you go about reducing medical denials? So, How Do You Reduce Medical Denials?

BHM Healthcare Solutions provides, as one of our many services, Denials Management. We have Denials Management Consultants who have created a 3 step process to reduce/eliminate health insurance claim denials which consists of analysis and assessment, implementation, and prevention.

The analysis and assessment process consists of:

1. Evaluate an organization’s processes, source of denials, as well as reasons for denials
2. Evaluate pre-service, concurrent, and post-service protocols
3. Develop and implement tracking methods
4. Review denied claim charts to determine their cause
5. Review both local and national regulations to determine if and how they are affecting denial rates

The implementation process will include:

1. A detailed strategy to target the denial and appeals process
2. Creating manageable protocols
3. Introducing improved technology
4. Implementing tracking and benchmarking procedures
5. Creating methodology to manage the appeals process easily
6. Providing training for utilization management and case management staff as well as any other applicable clinical staff
7. Assisting with the improvement of relationships and terms with payers
8. Developing an overall tracking method to determine denial causation

The prevention process occurs after the initial analysis and implementation processes have been completed. Prevention focuses upon:

1. Review managed care contracts that have a bearing on claims payment
2. Prevention of physician reviews
3. Training programs to address denial issues
4. Assessment of billing practices that may delay the claims process
5. Methodology to focus on denials and appeals
6. Training for utilization review and case management staff

About Us

BHM Healthcare Solutions is a healthcare management consulting firm with a breadth of services which include, but are not limited to, physician advisor services, denial management, revenue cycle, financial analysis, quality management, clinical improvement, training, compliance, and executive recruitment/interim staffing. Please visit our denials management webpage to see how we can assist your organization in reducing claim denials and call 1-888-831-1171 with any questions you may have or to schedule a complimentary consultation. Additionally, as a token of our appreciation, we have a free presentation regarding medical necessity. Please click on the gift box below to access. We look forward to working with you.