Optimizing claim denial management strategies can aid Medicare providers in recouping lost revenue and maximizing reimbursements. Medicare organizations most often lose a significant amount of yearly, monthly, and daily revenue just because they are unable to cope with claim denials effectively.

What is Claim Denial?

Claim denial is a refusal of an insurance company to honor the request of an individual to pay for his/her health care services obtained from a health care professional.  

Studies have found that 50-60% of denials never work. As per the American Medical Association (AMA), the most common reason is that doctors believe that administrative expenses imposed by the denial management process are not justified. And they would not be able to recoup enough money. Well, in reality, all practice needs to do is just audit and appeal the denials.

Why is it an issue?

Denied claims can easily become a major revenue issue for medical practices. Think about the amount you are leaving on the table by not properly managing denied claims. 

Most organizations lack the proper resources and training for an effective denial management strategy. They haven’t even set up Key Performance indicators (KPIs) to:

• track their denial rate
• track what percentage of denied claims are re-worked
• track how many re-worked claims turn into revenue. 

Most physicians are unaware of the extent of the problem they could be experiencing in their office. 

Alternatively, they may be fully aware of the complication attached to the unattended denied claims. Still, they are helpless as their staff lacks the requisite expertise to re-work denied claims. 

Whatever your situation, it’s important to collaborate with a denial management company. The company will ensure that you get every last penny that your practice is entitled to. Be aware that every claim denial creates a potential risk to your practice. To mark down this risk, you have to handle denial management effectively. Consider how Dominion revenue solutions can help:

• Support front office processes
• Set up KPIs to track denials
• Handle the medical billing process

Why Work With A Denial Management Company?

Denial management companies like Dominion Revenue Solutions provide crucial assistance for healthy cash flow and successful revenue cycle management.

We will step in to provide requisite support throughout the process so that your revenue cycle can go smoothly.

1. Optimize front end processes to minimize claim denials

At Dominion Revenue Solutions, we optimize the front-end process to minimize claim denials. We firmly believe that if you do it right up front, there are fewer chances of claim denial later on. Our team of professionals will ensure that your organization follows the best revenue management practices. 

• Eliminate facts that may lead/contribute to claim denial later on
• Review front-office processes, including documentation and billing preparation.
• Provide valuable suggestions to improve professions and increase your overall revenue collection.

DRS can also assist in handling front office processes for your staff. So now you don’t have to go through the hassle of hiring and training additional staff. Offload this step to our deep bench of experts. 

2. Help you track down KPIs to gain a better understanding of your financial health

As a physician, you need to stay informed about your medicare revenue recovery process. For this, you need access to the KPIs dashboard that will aid you in determining your denied medical claims along with re-worked and re-submitted claims. 

You have to ensure that denial management claims are trending in the right direction. We can help you set up KPIs to track your denied medical claims. 

DRS recommends tracking the following Key Performance Indicators to better understand your healthcare revenue recovery as it relates to denials. 

• Accounts Receivable: how much in revenue is waiting to be collected?
• Claim Denial Rate: the rate at which claims are denied? You could also break this down further into denied claims by procedures, groups of patients, etc.
• Cash Collections Percentage: how much of your practice’s expected revenue has been turned into cash coming into your practice?
• Cost to Collect: the cost that your practice uses to follow up on denied claims, re-work claims, and collect what you are owed
• Denial Write-off: Amount you are writing off as lost revenue because your practice is not re-working claims to receive payment for services provided.

Using a KPIs dashboard, you’ll be better prepared to drive towards continuous improvement.

3. Professional Support Assistance for Medical billing process

For medical offices that are resource-constrained or time-strapped, we can manage the entire Medicare billing process. With DRS, you don’t have to worry about hiring new talent with desired skills and experience. 

Our team of highly skilled professionals knows medical billing inside and out. We know how to manage the entire medical billing process, enabling your practice to capture every penny you owe.

Dominion Revenue Solutions aims to help you increase your revenue collection, so you can realize a significant ROI when you outsource medical billing. 

Don’t leave thousands of dollars to chance by overlooking claim denial management. Let our team of experienced professionals help your staff. We’ll take care of the details, so you can receive timely payments for each service that you provide to patients.