Denial Management Solutions
RMS Denial Management processes investigates every unpaid claim, uncover a trend by one or several insurance carriers, and appeal the rejection appropriately as per the appeals process in the provider contract. Denial management services implementations is a critical element to healthy cash flow, and successful revenue cycle management.
We use customized, systematic, hands-on approaches to ensure each claim receives the attention it needs to be resolved quickly. We ensure maximum results and improved and efficient collections. Each claim is analyzed, researched, and prioritize based on payer, amount, age of bill, or other customized business rules to ensure maximum benefits.
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PREVENTION - Prevention focuses on actions that can be taken to prevent the origination of denials. Prevention can be introduced anywhere in the patient encounter such as: pre-admit/pre-registration, scheduling, admit/registration and billing.
ANALYSIS - The process of analyzing and aggregating similar denials is strategic in denial management. The denial management team understands analysis and reporting is a forerunner to an effective follow-up process and hence for us it is a fundamental step in denial management.
TRACKING AND TREND MANAGEMENT - Our denial management experts ensure we track these trends and keep the client informed periodically about improvements/process that can be implemented across practice functions. Our experts actively monitor the payment patterns from various payers and set-up mechanisms to alert when a deviation from the normal trend is seen.
CLAIMS FOLLOW UP - RMS will monitor portions, or all, third-party and patient accounts. We handle these contacts professionally and thoroughly, reporting any problems or complaints to the office administration.
Our team of specialist fix the issues causing the denials (whether it be issues with the claims or issues with the payer), stop the torrent of unpaid claims into your medical billing process, and will help you optimize your medical billing and accelerate your cash flow.
Each denial case is unique. We take corrective action on all invalid or incorrect medical codes, provide supporting clinical documentation as needed, appeal any prior authorization denials, understand any genuine denial cases to pass the responsibility to patients, and follow-up effectively. We re-validate all clinical information before re-submission.
RMS is an extension of your organization's billing office, we work with you to analyze your denied claims and reduce denials over time.