Claim Denials

November 30, 2021

One of the biggest challenges facing most medical practices is the claims process. Filling claims with insurance companies can be quite time consuming and difficult – do it wrong and the claim could be rejected. Claim denials have a big impact on the bottom line of the practice, after all. It’s because of this that many practices are seeking to improve their denial management process.


The Cost of Claim Denials

It’s pretty clear that when an insurance company rejects or denies a claim, it will end up hurting the bottom line of one’s medical practice. However, claim denials can be costly in another way as well – more time and effort will need to be spent in order to appeal the claim denial. This requires someone on staff to carefully look over the denial, identify why the claim was denied and then make an argument for why the denial should be overturned. Whoever files the appeal will need to have in-depth knowledge about the appeal process. There’s no bigger waste of time than incorrectly filing an appeal to a claim that wasn’t filled properly to begin with. And time is money.

How a Better Denial Management Process Can Help

There have been a number of recent studies that have revealed that the implementation of improved up-front procedures and advanced EHR clinical alerts that are based on specific health plan requirements can help reduce the number of claim denials by as much as (or even more than) 80 percent. It’s been shown that instituting a comprehensive denial management program could increase the take home pay of physicians by upwards of 15 percent.

A good denial management process not only improves the success rate of claim denial appeals but will help prevent many denials from occurring in the first place. A denial management process should include thorough denial assessment that makes use of data collection and analysis in order to identify denial causation by denial type and payer.

How ProMD to Improve Denial Management Process

In order to improve the denial management process of a medical practice, a lot of time has to be spent on the workflow. Because it can be costly and difficult to set up an effective denial management process in-house, it’s generally a good idea to outsource one’s billing and collection services.

ProMD makes use of a process and infrastructure that has been proven to ensure that medical practices receive more profitable claim payments in a shorter period of time with an error rate that is minimal or non-existent. On average, ProMD clients achieve collection rates of 90 to 98 percent.

Some of the services that ProMD will provide in order to achieve these high collection rates include charge posting, billing, collection, denial appeals, payment posting, billing and collection reporting, account receivables analysis and the implementation of an ongoing practice management system, which is free of charge.

Cut down on lost money by reducing claim denials and implementing a more effective denial management process. For information about improving your denial management process or for information about our medical insurance billing and collection services in general, be sure to contact us at ProMD today.

ProMD Practice Management is happy to help with your billing assessment needs so you can maximize profits and increase patient satisfaction. To learn more about how ProMD can make your practice run like a well-oiled machine, call 888-622-7498 or fill out our online form to request a billing assessment.

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