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Denial Management Solutions

Our Denial Management processes at RMS involve a thorough investigation of every unpaid claim. We meticulously uncover trends across one or several insurance carriers and strategically appeal rejections according to the established appeals process outlined in the provider contract. The implementation of our denial management services is a crucial component for maintaining a healthy cash flow and ensuring successful revenue cycle management.

To achieve optimal results and enhance overall collections efficiency, we employ customized, systematic, and hands-on approaches for each claim. Our dedicated team ensures that every claim receives the attention it requires for swift resolution. Through detailed analysis, research, and prioritization based on payer, amount, age of the bill, or other customized business rules, we guarantee maximum benefits for our clients. This proactive approach not only addresses denials effectively but also contributes to improved and efficient collections processes.

The Fundamentals...
A team discussion at a trading room

PREVENTION: Our Prevention strategy is centered on proactive measures to forestall the occurrence of denials. This can be implemented at various stages in the patient encounter, including pre-admit/pre-registration, scheduling, admit/registration, and billing.

ANALYSIS: The systematic analysis and aggregation of similar denials form a strategic pillar in our denial management approach. Recognizing that effective follow-up hinges on robust analysis and reporting, we consider this step fundamental to our denial management process.

 

TRACKING AND TREND MANAGEMENT: Our denial management experts are dedicated to tracking trends and providing clients with periodic updates on improvements and processes that can be implemented across practice functions. Actively monitoring payment patterns from different payers, we establish mechanisms to alert stakeholders when a deviation from the normal trend is detected.

CLAIMS FOLLOW-UP: RMS takes charge of monitoring portions, or all, third-party and patient accounts. Our team handles these interactions professionally and meticulously, promptly reporting any issues or complaints to the office administration.

We are here to assist...

Our specialized team is adept at addressing the root causes of denials, whether they stem from issues with the claims or problems with the payer. We not only halt the influx of unpaid claims into your medical billing process but also strive to optimize your medical billing system, expediting cash flow.

Recognizing the unique nature of each denial case, we tailor our approach to address specific challenges. Our corrective actions include rectifying invalid or incorrect medical codes, furnishing necessary clinical documentation, appealing prior authorization denials, understanding genuine denial cases to communicate effectively with patients, and conducting thorough follow-ups. Before resubmitting claims, we meticulously re-validate all clinical information.

 

Consider RMS as an extension of your organization's billing office. Collaborating closely with you, we analyze denied claims and implement strategies to progressively reduce denials over time.

Medical Billing

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