Article Highlights

• More than half of denied claims are not re-worked, leaving thousands of dollars on the table.
• Optimizing front office practices can help with denial management.
• Outsourcing medical billing to a denial management company can help physicians collect every owed dollar.

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Physicians often lose significant amounts of revenue on a daily, monthly, and yearly basis because their office does not properly manage claim denials. Denied claims can easily become a major revenue issue for medical practices if they do not re-work and re-submit claims.

In fact, studies have found that 50-65% of denials are never worked. Think about how much revenue your office could be leaving on the table if you do not properly manage denied claims.

Unfortunately, many physicians have not set up Key Performance Indicators (KPIs) to track their denial rate, to track what percentage of denied claims are re-worked, and to track how many re-worked claims turn into revenue. Physicians may not know how large of a problem they could be experiencing in their office.

On the other hand, you may know exactly how significant the issue is in your practice, but you feel helpless to do anything about it because your staff lacks the time or expertise to re-work denied claims.

No matter your situation, it’s important to work with a denial management company to help ensure that you receive every dollar that your practice is entitled to. Remember that every denial creates risk for your practice. You need to reduce this risk by making sure that denials are managed. Consider how Precision Medical Billing (PMB) can help:

• Support front office processes
• Set up KPIs to track denials
• Handle the medical billing process

Why Work With A Denial Management Company?

Denial management companies such as PMB can help create structure and consistency to how your practice manages denials. Consider how we step in to provide support throughout the process so that you can collect the revenue you are owed.

1. Optimize Upfront Processes

A denied claim doesn’t happen by accident. Something went wrong at some point in the process, whether it was the information collected about the patient, the information that was entered in your EMR system, the hand-off from one office worker to another, or the actual submission process.

When you work with PMB, we help optimize processes in your office to support the claim submission process on the front-end. We believe that if you get it right up front, then there is less chance of a claim being denied later on. Our team can help by ensuring that your team is following best practices:

• Review front office processes, including documentation and billing preparation.
• Eliminate factors that could be contributing to claims being denied.
• Make suggestions for how to improve processes that increase revenue collections.

We can also step in to handle front office processes for your staff. You may find this a reliable alternative compared to hiring and training additional staff. You could offload this step to PMB because we have a deep bench of experts to take care of this for you.

2. Help You Utilize KPIs

Physicians need to stay informed about how their office is handling denied claims. You need access to a KPI dashboard that will help you understand how often claims are denied, how often they are re-worked, and how often re-submitted claims are approved.

You should also be able to see whether improvements have been realized to make sure denial management is trending in the right direction. If you do not have access to this level of detail in the claim denial process, then we can help set up KPIs to track your denial rate.

We recommend tracking the following KPIs to help you gain a better understanding of the financial health of your practice as it relates to denials:

• Accounts Receivable: how much in revenue is waiting to be collected?
• Cash Collections Percentage: how much of your practice’s expected revenue has actually been turned into cash coming into your practice?
• Claim Denial Rate: how often are claims denied? You could also break this down further into denied claims by procedure, groups of patients, etc.
• Cost to Collect: how much does it cost your practice to follow up on denied claims, re-work claims, and collect what you are owed?
• Denial Write-off: how much are you writing off as lost revenue because your practice is not re-working claims to receive payment for services provided?

Information is powerful. Using a KPIs dashboard, you’ll be better prepared to ask questions and find answers to drive toward continuous improvement. You’ll also be able to hold your office accountable for following up on denied claims.

3. Take Advantage of PMB To Support the Medical Billing Process

For offices that are time-strapped or resource-constrained, we can support the entire medical billing process. We understand that medical offices often experience turnover, creating issues with maintaining a high-performing staff.

When you work with PMB, you don’t have to worry about constantly training new employees or trying to find new talent that has desired skills and experience in medical claim management.

Our team of highly-trained experts knows medical billing inside and out. We know how to manage the entire medical billing process, enabling your practice to capture every dollar that you are owed.

In fact, we have a 98% claim acceptance rate. And, we stay on top of any claims that are denied to ensure they are re-worked and re-submitted. The result for our clients is that we increase revenue for 100% of the physicians that we serve.

Talk to PMB About Supporting Claim Denials

Our goal at PMB is to help you increase revenue collections and realize a significant ROI when you outsource medical billing. Our team of experts will handle the process at a fraction of the cost compared to hiring new employees or pulling current staff away from other duties to train them on denial management.

We also strive to decrease the administrative burden placed on your staff by providing you with a single point of accountability for who is responsible for managing denied claims. You will know exactly where to turn for answers to your questions when you review the denial KPIs.

Don’t leave thousands of dollars to chance by overlooking denial management. Let our team of experts help your practice. We’ll take care of the details so that you can receive payment for each service that you provide to patients.

Contact us today for a consultation to discuss your practice and our services.