Get Support for Denial Management in Medical Billing
A claim denial—when the insurance company refuses to release funds to the healthcare provider—can happen for several reasons. But it immediately leads to revenue delay (in case of appealable denials) or revenue loss (for irreversible denials). That is why denial management in healthcare RCM is critical to a healthy revenue flow.
SunTec India- a leading healthcare BPO company - helps you deal with these issues. Our medical claims denial management services are HIPAA-compliant. We appeal soft clinical denials, fix incorrect medical codes, gather and resubmit supporting clinical documentation, and follow up with the payers to resolve the denial. To prevent claim rejections in the first place, we also offer revenue cycle management services.
Get the following benefits with our denial management services.
- Resolve clinical denials and recover payments sooner
- Reduce A/R days
- Improve clean claims ratio
- Get proactive denial prevention support
Optimize Revenue Cycle for Your Healthcare Firm with SunTec
- Medical billing experts to quickly correct and resubmit denied claims
- Revenue cycle optimization experts to prevent claim rejections in the future
Denial Management in Healthcare- How SunTec Helps
Identify the Cause of Denials
When claims are rejected or denied, the insurance company usually returns an explanation of benefits (EOB) and electronic remittance advice (ERA). We analyze both to identify what caused the denials and either apply the required corrections to the claim or start the appeals process. We also check for outstanding claims (with no response from the payer for 30-45 days) and reach out to the payer via their portal or other available communication channels.
Classify & Sort the Denials
A claim may be denied or rejected due to coding errors, incorrect information, duplicate claims, missed deadlines, lack of patient eligibility (no preauthorization), or several other reasons. We categorize the denials by cause and direct them to the responsible team member for immediate resolution. Additionally, classifying and analyzing the reason for medical claim denials enables us to identify opportunities to revise processes and adjust workflows to ensure claim denial prevention in the future.
Correct and Resubmit Claims
We resubmit the claims based on the case, the cause of denials, and the insurance payer’s policies. Depending on the case, this involves attaching additional documentation to the claims, correcting medical billing or coding errors, verifying patient eligibility, and checking payer coverage rules.
Appeal Hard or Irreversible Claim Denials
These cases are considered claim rejections, wherein the insurance payer disagrees with a coverage or payment decision and refuses to pay the healthcare firm. We use the state and federal guidelines to appeal such cases. For instance, Medicare offers different CMS forms to appeal denials. We identify the category and fill in the details accordingly to ensure a fair chance of reversing claim rejections.
Monitor and Prevent Denials
Our healthcare denial management services are interlinked with denial prevention support. We utilize the data gathered during the denial management process to prevent future claim denials and rejections and improve revenue cycle management.
What Causes Claims Denials?
Incorrect/Inaccurate Patient Information
Simple mistakes like a misspelled name or inaccurate patient information that does not match the insurance company’s records
Invalid Medical Code
Inaccurate medical codes (not following standard medical coding and classification systems) that do not match physician documentation
Lack of Documentation
Insufficient documentation support or contradicting documents
Non-Covered Ailments
Claims for ailments which are not covered under the patient’s insurance policy
Why Outsource Denial Management Services to SunTec?
SunTec India is a leading provider of healthcare BPO services. Our team has helped hospitals, independent physician offices, billing services, pharmacies, and other healthcare firms reduce their claim denial rates by considerable margins. From end-to-end RCM outsourcing to standalone medical billing, medical coding, insurance pre-authorization, medical records indexing, charge entry, and payment posting services, we offer all the support a healthcare provider may need to streamline RCM.
$240K+ Recovered through Prompt Denial Management
95%
Clean
Claims Ratio
70%
Success Rate
of Appeals
“Outsourcing to SunTec was absolutely the right call for us. They recovered significant revenue and ensured efficiency throughout. I would recommend it to other organizations that have similar problems.”
VP- Accounts
Healthcare Denial Management Services: FAQs
1. How much do denial management services cost?
The cost of denial management in healthcare varies depending on the scope of services and the size of the healthcare organization. Contact us at info@suntecindia.com for a customized quote based on your specific needs.
2. What are the terms of your SLAs regarding response times and issue resolution commitments?
Our SLAs include guaranteed response times. The window for responding to low, medium, or critical issues is determined after discussion with each client. This window can vary from thirty minutes to hours/days, depending on client preferences.
3. How do you handle confidential patient information?
We are an ISO-certified healthcare denial management service provider. To protect sensitive/confidential data, we also sign non-disclosure agreements (NDAs) and conduct periodic security reviews.
David Barrs, President
VisionSpan Corporate Communications, Inc., USA