Investing in Denial Management Improves Revenues for Healthcare Providers

It’s an understatement to say that healthcare in the United States is complicated. It doesn’t just end at doctors finishing their consultation and prescribing treatment. After the doctor-patient encounter, the visit is documented and later coded to show the medical services rendered. Later on, this information is filled out as claims to insurance payers, following which payers verify the claim and reimburse the doctor. However, not all claims are accepted by payers. Quite a few of them tend to get denials management software. That’s when the physician’s payment is delayed or even lost.

 

That’s why it has become important for providers to invest in a denial management. It helps identify the causes of denial, highlights if a certain claim is likely to be denied, and minimizes the likelihood of claims getting denied in the future.

 

When an insurance payer refuses payment for a certain claim, such as a particular test, prescription, or any medical procedure, the claim is said to be denial management solutions. Let’s explore some of the reasons for a claim to be denied – 

• The cost in the claims might be more than what the health plan covers

 

• The health insurance plan might not cover what is being claimed

 

• The medical procedure might be declared to be unnecessary by the payer

 

• The patient may have used providers that are not in the payer’s network