denial management - don't throw money awayA recent MGMA report showed that the average cost to rework a claim is $25. That means every claim that’s denied or rejected—every claim—is costing you an average of $25.

Let’s do the math: If your staff must rework 100 claims every month, it’s costing you:

$2,500 per month

Why let that revenue flow out your door?

By analyzing and fixing the problem, whether with one biller, practice-wide or with a particular payer, you can save your practice a substantial sum of money that goes right to the bottom line.

In a post on the MGMA In Practice blog, analyst Frank Cohen, MBB, MPA, pointed out that by using your medical billing software to analyze claims that come back, a practice can identify and fix these problems, thereby avoiding an additional cost of 20-30 percent to work the claim.

“In these situations, I analyze the reason and remark codes by payer for each of those rejections and denials,” Cohen explained. “I do a correlation analysis, and I’m trying to see if there’s a pattern.”

Cohen points out that if a practice always gets rejections with a particular diagnosis, “then I can look and see if there’s a pattern. If that’s the case, I can fix it once—and I’ll be fixing it for all the other times that rejection or denial comes through.

“Maybe I’m getting denied because there’s a certain modifier I’m not using when I should be. Then all you have to do is adapt to whatever the appropriate action would be,” Cohen explains.

Best practice is to review reports on your denied claims at least once a month and analyze what is causing the problem. Is it one coder who simply needs more training? A modifier that should be used but is missing? Is it a problem to be addressed with a payer?

Once you identify the problem, you can find a solution to resolve that particular issue on a global level, rather than having to address each denial as it comes in. But keep in mind that new problems are likely to crop up each month; that’s why a regular review of denial reports is important.

Get help with denial management

We strongly recommend this global approach to denial management, and that’s why MediTouch® medical billing software is designed to help you manage and avoid denials. Using MediTouch, you can conduct this analysis with monthly reports that track your adjustment codes. In addition, as you view and manage your ERAs our system flags the ones that have been denied by the payer.

MediTouch also offers Denial Defender®, a unique system that identifies problems with claims before they are rejected or denied. This easy to use, “at-a-glance” system is designed to make recommendations on the use of billing codes and modifiers, increasing your percentage of clean claims and speeding your payment rate.

Denial Defender employs a database containing tens of thousands of coding rules. Using that data, Denial Defender:

  • Verifies modifier usage
  • Checks for CCI bundling edits
  • Determines code validity
  • Validates pass-through items
  • Verifies medical necessity

Plus, Denial Defender provides the Relative Value Unit (RVU) of each procedure, helping billers to maximize reimbursement. Taken together, these tools comprise one of the best denial management software systems available, insuring your reimbursement and speed of payment are optimized.

Be sure to analyze and manage your denials and rejections to improve your profitability. To learn more ways you can reduce denials and improve your bottom line, register now for our upcoming webinar, Don’t Be Denied: Avoiding Billing and Coding Errors, with expert Betsy Nicoletti.