Healthcare Denial Management Services

Estimates of denial rates in healthcare claims range from 5 to 25%, which illustrates the lack of standards and industry issues. With a track record of success and a wealth of knowledge, MediBill Health Partners's rejection management services are essential for reducing denials, challenging denied claims, and maximizing revenue recovery. Our dedication to quality aids in assisting healthcare professionals in overcoming financial instability and navigating denial difficulties.
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    MBHP's Effective Healthcare Denial Management Approach

    Identifying Underlying Causes

    Our skilled team quickly pinpoints the root causes of denials and develops targeted strategies to prevent similar issues from arising in the future.

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    Claim Denial Resolution

    Our advanced stretagies for managing claim denials allow us to swiftly address issues and reduce delays.

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    Follow Ups and Conciliation

    We diligently track claims and leverage patient benefit information to negotiate the best reimbursement rates from insurers.

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    Prompt Denial Appeals

    Our thorough appeal process is designed for speed and efficiency, incorporating meticulous claim tracking to ensure timely resolutions.

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    Revenue Recovery Expertise

    We focus on reclaiming lost payments from denials, allowing you to concentrate on your core operations without financial stress.

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    Analytics and Insights

    We deliver in-depth data analysis to help you identify opportunities for enhancing your practice's future performance.

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    What is Denials Management Service?

    The crucial process of healthcare denial management include determining the causes of medical claim denials and putting preventative measures in place. A crucial component of this endeavor is proactively raising the rate of initial claim reimbursement.

    To achieve effective denial management, consider the following factors:
    • Full insight into healthcare practice performance through detailed analytics and reporting
    • Determining the causes of claim denials
    • Minimizing denied claims and maximizing the number of claims paid
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    Root Cause Evaluation

    A thorough root cause analysis is the first step towards providing medical billing denial management services that work. Preventing denied claims from happening in the first place is the most effective strategy to lessen the financial losses they cause. The following are some typical explanations given by different medical specializations for claim denials:

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    Incomplete or inaccurate information
    There are various reasons why claim denials may occur, including incomplete fields (e.g., Social Security number or demographic information), incorrect plan codes, or coding errors such as missing modifiers.
    Duplicate Submissions
    Claims submitted more than once for the same visit, on the same day, by the same provider for the same patient.
    Out-of-Network Provider
    When services are rendered by an out-of-network provider, the payer may reject the claim partially or entirely.
    Pre-authorization
    Claims may be denied if prior authorization is not secured before the service is provided. Payers often update the list of services that require prior authorization.
    Benefits Coordination
    When a patient has multiple health insurance plans, claims may be delayed or denied until the coordination of benefits is properly updated.
    Failure to Meet Medical Necessity Requirements
    When a healthcare service is considered medically unnecessary, the policy excludes coverage, and there is a disagreement between the payer and physician about the appropriate treatment for your condition.
    The payer does not cover the procedure
    In many cases, this can be prevented by reviewing a patient’s insurance policy or contacting their insurer before submitting a claim. The payer might deny a claim if the procedure performed is not covered.
    Surpassed the timely filing deadline
    When a claim is submitted beyond the payer's specified filing period, this factor should be taken into account when addressing rejected claims.
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    Achieve Optimal Denial Management with MBHP

    Ensuring that your insurance claims are complete, accurate, and ready for processing by the insurance company is a significant achievement in itself, as it prevents potential revenue losses for your organization.

    Here are four additional reasons to implement MediBill Health Partners Perfect Denial Management in your practice:
    • To prevent future denials, the process can help pinpoint areas needing improvement
    • Part of our denial management strategy, we track, prioritize, and appeal denials by utilizing case citations and state/federal statutes that support your organization's appeal
    • By collecting and analyzing denial patterns, we gain insight into their root causes, allowing the denial management team to create lasting solutions for these issues
    • By utilizing our denial management service, healthcare organizations can obtain more detailed information to bolster appeals, potentially leading to increased claim payments

    Request a Quote for Our Comprehensive Denial Management Service

    Contact our experts at MBHP for high-quality, clinically focused, and cost-effective denial management services.

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    Benefits of the A/R and Denial Management Process with MBHP

    With our comprehensive A/R and denial management services, we provide the following benefits to our customers:
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    Concentrate on resolving claims

    Our main focus is on resolving claims, not just obtaining information about their status.

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    Filing Appeals

    MBHP’s skilled team reviews denial reasons, drafts appeal letters, and resubmits claims with the necessary clinical documentation via fax, adhering to the payer’s required format.

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    Automated Processes

    By enhancing our use of web portals to check claim status online, we have reduced the effort needed to track claims.

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    Automated Workflow

    Insurance companies must address a series of questions related to each claim status code to resolve claim issues. To improve documentation quality, we have organized our claims follow-up processes using web-based workflow systems.

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    Dashboards and Performance Metrics

    By utilizing multi-variate reports, we gain a thorough understanding of our accounts receivable and focus our efforts on resolving these accounts efficiently.

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    Enhancing collections and shortening days in accounts receivable

    Our clients experience at least a 25% reduction in days in accounts receivable and a 15-20% improvement in collections.

    MediBill Health Partners: Where Precision Meets Performance in Denial Management

    At MBHP's, we strongly believe in the power of the right people and the right processes to overcome any challenge.

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