Denial management in healthcare is a highly critical process that evaluates the cause of claim denials and takes necessary steps to prevent them. The denial management includes the creation of specific procedures for refiling or appealing the denied medical claims.
Denial management companies need to identify the possibilities to identify and correct the issues those cause claims denials. The healthcare denial management systems work to classify the claim denials by cause, source, and other distinctive factors to develop and assess smart denial management strategies. OSP’ custom denial management services help healthcare organizations to implement best denial management strategies that identify and turn the denied claims into accepted ones.
The common bottlenecks which might slow down your business growth
Paper-based claims scrubbing systems lowering the success ratio of denial management.
Lack of customizable and real-time analytics to analyze the performance of submitted claims.
Inability to efficiently comply with essential healthcare data compliances like HIPAA.
Lack of automated claims scrubbing due to time-consuming and manual coding process.
Lack of qualitative denial management audits to formulate a successful strategy.
High amount of coding errors raising the number of claim denials and lowering revenue collections.
Lower claims denial ration and improve A/R recovery with denial management in RCM.
Denial management in healthcare is one of the most crucial elements that ensure steady cash flow and powerful revenue cycle management. Denial management services include identifying the key problems that cause claim denials, classify them based on cause & source, and develop an effective denial management software strategy.
We provide tailored denial management solutions that help to enhance their clean-claims rate, manage denied claims effectively and have proficient assistance in handling the appeals. Our healthcare denial management can help providers to identify and exact causes of denials to improve your clean-claims rate. It can streamline workflows for faster appeals and improved cash flow while lowering the cost of managing denied claims and the administrative burden. Resolving underpayments while reducing regulatory risks to keep the financial performance optimum is the primary goal of OSP’ tailored healthcare denial management systems.
A well-defined advanced payer rule engine helps to track payer-specific rules for claim payments, identify their denial activity and recognize new rules. Defining claims qualification for each payer within the system can be made possible with a sophisticated payer rule engine. It can anonymously track these rules for each user base and automatically distribute current rules over the entire network.
OSP can build a custom denial management in medical coding that can assess your 835-remittance data to reveal the major reasons causing the claim denials. Our tailored healthcare denial management systems can analyze, track, and create intuitive reports on denial data in order to discover unpublished payer rules. We can customize the denial management software to recommend the relevant fixes for each denied claim. A rule engine can help implement the right billing processes to reduce the denials rate and increase revenue flow.
The potentially high cost of appeals emphasizes the value of implementing an effective denial management process. An organization’s clean claim rate is one of the highest priorities. Clean claim rate (CCR) is defined as the ratio of passed claims that pass edits cleanly. The cleans claims do not require any correction or manual work prior sending it to the payers.
Our denial management in medical billing helps to simplify the transactional complexities between providers and payers by creating a seamless process of error-free claim submission. Though our custom denial management services, we focus on increasing the CCR through the revenue cycle to the point of claim creation, data collection has been correct and efficient. The solution can be tailored to provide timely claim alerts to notify them being flagged by the rule engine.
In-depth analysis of root cause of the claim denials is highly crucial for denial management in US healthcare. As per the HIMSS analytics survey of 2016, more than 50% of hospitals do not leverage denial management analytics, eventually failing to reduce the denial ratio. The analysis helps to understand the standard triggers which cause claims denials instantly and the current faulty system can be optimized for better results.
We help the provider to understand the denial data and make it meaningful for the users with real-time analytics and easy-to-understand dashboards. Denial management medical billing can be made effective by visualizing the highly common denial trends. Healthcare denial management can be focused on these trends to create a smart action plan with alert parameters. The dashboard provides valuable performance metrics like initial denial rate, the rate of appeals, and win/loss ratio to streamline healthcare denial management in RCM.
Automated claims management system or medical clearinghouse solutions are the most important part of denial management solutions. Before submitting the electronic claims to the payers, the in-house medical clearinghouse solution scrubs the claims for any missing data to validate the claims against payer-specific rules. Providing all users with a single, on-demand solution for managing every aspect of claims denial, from receipt to resubmission is the highest need of the hour.
OSP’ advanced claims management solutions thoroughly scrub the claims and flag those require review. This help to resolve the issues and errors before submitting the claims. A detailed claims processing report offers a complete list of errors and causes of rejections which are needed to be resolved for claim submission. Healthcare denial management systems can be customized for payer-specific rules to optimize the efforts of claims processing.
As per the Advisory Board’s survey, the provider claims denial appeal is not a successful venture. The success rate for such appeals has dropped from 56% to 45% for private health plans. Denials for the patient in the emergency department are easy to appeal but managing the appeals successfully for a person being treated for a longer period of time is a cumbersome task.
OSP can replace the manual process of appeals and grievance management (A&G) by streamlining the complete process through automated denial management in US healthcare. A smart interface can help you to manage a seamless workflow for effective denial management in medical coding. Automating the ongoing manual appeals management process can help providers to reduce stress, time and money needed to invest to get reimbursed for their authentic medical claims.
OSP has worked with Stephen to create a mobile health application offering 'Doctor on Demand'. This mhealth solution is based on the Uber model to enhance the availability of health access in the US.
A US-based billing company wanted to build an automated and cloud-based claim review system to identify claim errors. The enhance accuracy of the adjudicated claims and avoid long turn-around time was the ned of the hour.
Patient authorization, Pokitdot APIs, and claim scrubbing module based on AETNA guidelines helped them to enhance the claim processing workflow.
The solution comes with-
A US-based clearinghouse, managing millions of claims amounts every day, wanted to go paperless with an automated claim management software solution. They had a medical billing system connected to VersaForm practice management system that helps them to manage billing and claim data.
The need of the hour is to replace existing Microsoft Access based application with a web-based system hosted on the cloud server that can be accessed from anywhere, anytime.
The solution comes with-
A Texas-based mental health center wanted to reinvent the medical billing process and enhance approval rates which were 10% against 100 claims submitted.
It was challenging to manage multiple insurance providers for a large clinic set up for a health specialty that needs flexibility in billing, workflow automation, accurate claim scrubbing, and fill regulatory compliance gap.
The solution comes with-
The goal of a healthcare claim management organization in California is to replace paper-based claims processing with an advanced automated medical billing solutions & claims management system. The system required to be used across a broad-spectrum including doctors, nurse practitioners, and payers to manage the dental patient.
The challenge was to bring various individuals involved in the dental claim management process from a community center, dental health providers, medical coder & biller to payer and government under the same roof.
The solution comes with-
A Large physician practice in the US wanted to bring together advanced revenue management for its healthcare providers, clinicians, and patients. Our client wanted to manage claim backlogs, modernize back office operations, and enhance transparency in billing.
OSP built a revenue cycle management solution that ensures ease out billing processes while ensuring HIPAA & PCI compliance to Strong SSL certification.
The solution comes with-
Denial management in healthcare needs performance auditing to scale the efforts with maximum efforts. OSP' can build made-to-order denial management software that can easily address the auditing challenges with qualitative and flexible management featuring comprehensive reporting and configurable workflows. Our denial management in medical billing helps in conducting audits for coding errors, write-off adjustments, remittance advice reviews, zero payment claims, and insurance verification quality.
Capturing charges automatically helps to streamline the data entry process. OSP' denial management medical billing helps to check claims in real time to validate diagnosis and procedure codes. The advanced charge entry analysis is one of the most effective strategies to ensure compliance before claim submittal. We can customize denial management software to perform real-time code check integrated with your charge entry process. In-depth charge entry analysis can provide the list of common billing errors, that can help to work upon the claim status and denial management.
Denials workflow plays a vital role in streamlining the denial management process. Through smart denial workflow management, we help eliminate the manual claims review status process and remittance advice. With an automated denial workflow, the clients can have a view of claims that require follow-up, categorized by the root cause, so you can efficiently resolve the issues. An intelligence denial management healthcare workflow engine applies client-specific logic to efficiently distribute submission-ready denied claims to the right processes. The guided workflows help to prioritize the right work on the right accounts to save time and stress.
Stay current with resources that talks about your business, curated by our experts
Let us address your challenges with our solutions