Denial Management in Medical Billing Services
Denial management in medical billing is one of the most arduous processes and is often overlooked by physicians and medical practices due to their busy schedules and primary focus on patient care. As a result, claim denials accumulate over time, causing disruptions to the entire billing process and negatively impacting the financial stability of the medical practice if not addressed promptly. Therefore, it is essential for every medical practice to have a proper denial management system in place to maintain claim quality and protect revenue.
Denial management is not just about working on denied claims—it also involves streamlining processes, improving claim quality, focusing efforts on uncollected revenue, and maximizing collections. Additionally, it includes identifying recurring denial reasons and educating the claims processing team to minimize future denials. With MGSI as your Medical Billing and Denial Management partner, you can experience increased collections and improved claim quality.
Denial Management Process at MGSI
Claim denials occur for various reasons. While the primary goal is to reduce the denial percentage by increasing the first-pass resolution rate, claim denials are inevitable, making an efficient and timely denial management process crucial. The denial management team must be experienced in identifying the cause of claim denials and reworking them within the required turnaround time (TAT) to ensure successful and profitable processing.
The key steps in MGSI’s denial management process include:
- Identifying Claim Denials – A proper and efficient claims tracking system is essential to detect and address claim denials promptly.
- Analyzing and Correcting Denied Claims – Once a claim denial is identified, the denial management team conducts a thorough analysis to determine the reason for the denial, correct any errors, and resubmit the claim to the insurance company.
- Filing Appeals – If necessary, the denial management team submits appeals with supporting documents to justify the claim and follows up to ensure reimbursement.
- Continuous Follow-Up – Regular follow-ups with insurance companies are conducted to ensure appeals are processed in a timely manner.
- Preventing Future Denials – The denial management team also works proactively to prevent claim denials by educating the medical billing and coding team about common denial reasons, thereby improving the accuracy of future claims.
MGSI has been a trusted partner for over 600 physicians nationwide, providing complete Revenue Cycle Management services across various specialties. With over 30 years of experience in medical billing, MGSI remains a leader in the industry. Leveraging our denial management expertise can have a positive impact on your practice and monthly revenue.