Medical Billing and Revenue Cycle Denial Management

BySento G

Medical Billing and Revenue Cycle Denial Management

The term Revenue Cycle Denial Management has been widely used all over the world in the realm of Medical Billing Process. In fact, it is being abused frequently. While some people make use of the term for describing the way of tracking information related to particular payers or group of processes, others use this for explaining about claims that have been denied due to medical needs. There is another group of people who use the word to define their everyday activity at hospitals.

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It will be amusing to check with the billing department of a medical practice about what their strategy toward Revenue Cycle Denial Management is and how they systematically measure and view its results in quantifiable form. They may not have the answers. Not many billing departments understand the vital role played by a reliable Revenue Cycle Denial Management System and its benefits to the medical facility.

A decent Revenue Cycle Denial Management System offers systematic administrative data to aid the billing process and this data can subsequently be used for accelerating and increasing cash flow. This useful service is achieved by the system through tracing, computing, and reporting properly about all claims that have been billed but were denied by payers. Such reporting needs to be comprehensive while tracking each and every denial. When properly used, it can cut down first-time claim refusals to half.

There are quite a few practices that do not have means of observing whether payers are denying claims excessively or at unreasonable rates, and way of finding reason for denial. They are evidently losing a considerable portion of their revenue due to this. Billing processes of such practices lack administrative reporting skill required for meaningfully and concisely extracting data. These troubled billing procedures also lack in measured and systematic billing operations required for correcting mistakes.

At Numina Medical Billing Services, we aim at achieving two major purposes, namely, providing details of how many claims have not been paid by payers during first submission, and solving these issues. Numina’s Revenue Cycle Denial Management Software is built with databases that are developed for tracing, computing, and reporting about all denials. Payer wise tracking of number of denials and reason for denials is performed and reports are prepared. This helps identify payers who deny claims unwarrantedly and compare such payers with their peers to discern trend patterns and achieve follow-up. Based on these, we formulate rules for preventing payer denials in future. Payers who are found to be chronic violators are monitored for when and how they wish to process pending claims and make payment. In case such issues persist, legal possibilities to penalize will be considered.

By quantifying and examining the claim denial problem, a true Revenue Cycle Denial Management Software System improves billing process while accelerating and optimizing cash flow. It helps improve the revenue of the practice substantially.