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Effective Denial Management

Effectively managing your claim denials is key to ensuring maximize claims reimbursement revenue and prevent denials.


The importance of denial management cannot be ignored in the healthcare industry, the way any healthcare organization manages denials has a major impact on its financial stability.


How to improve Denial Management


1. The need to understand why claims were denied: Identifying the major reasons for denials, is the first process to maximize your revenue collections and prevent future claims from getting denied.

2. Complete claim denials within a week: Creating a strong workflow for you denied claims is paramount to establishing a successful denial strategy. When you receive a denial from an insurance company, you should have a process in place to ensure that denial will be corrected within a week.

3. Create a tracking & reporting process: Establishing a denial reporting report that can track your claims as they enter and leave your system allows your organization to measure your performance over time especially as many insurance companies set limits on how long a hospital or medical practice has to appeal a denial.


4. Track your progress and appeals: Keeping track of your appeals and results. Identifying the types of denials that are most common to your organization is also a crucial component of establishing an effective denial management process. After all, the ultimate goal is improving the efficiency of your organization.

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