- Eligibility and Benefits Verification
- Patient Demographics Entry
- Charge Entry
- Medical Coding Services
- Claims Submission Work Edits and Rejection
- Payment Posting Services
- Accounts Receivable Management
- Denial Management Services
- Coding Denial Management
- Credit Balance Services
- Patient Statement Services
- Revenue Cycle Analytics
Comprehensive Denial Management Services
Denial management in healthcare encompasses both rejected and denied claims, requiring meticulous investigation, resolution, and, if necessary, appeals to optimize revenue cycles. At NTMD RCM PRIVATE LIMITED, our denial management team comprises seasoned professionals dedicated to addressing each denial case with precision and efficiency.
Understanding Denial Management in Healthcare
While rejected claims are those that haven’t entered the payer’s adjudication system due to errors and require correction and resubmission, denied claims represent lost or delayed revenue, demanding thorough investigation and remediation. Successfully appealing denied claims entails root-cause analysis, corrective actions, and strategic appeals to maximize revenue recovery.
Our Denial Management Service Offering
- Our denial management team:
- Investigates the reason for every denied claim
- Focuses on resolving underlying issues
- Resubmits requests to insurance companies
- Files appeals as necessary, attaching supporting clinical documentation
- Revalidates all clinical information before resubmission
Recognizing the uniqueness of each denial case, we correct invalid medical codes, provide necessary clinical documentation, appeal prior authorization denials, and effectively communicate genuine denial cases to patients.
Filing Appeals
We meticulously analyze denial reasons, draft appeal letters, and refile claims with attached clinical documentation, utilizing payer-specific formats and fax appeals where required.
Reducing Denials Through Analytics
Identifying trends in claim denials, we initiate iterative processes to address specific causes, thereby reducing denial rates over time.
Benefits of Our A/R and Denial Management Process
Our comprehensive A/R and denial management services offer numerous benefits:
Focus on Claim Resolution: Prioritizing resolution over mere status information retrieval.
Process Automation: Leveraging web portals to streamline claim status checks and minimize manual effort.
Workflow Automation: Implementing web-based workflow systems to enhance documentation quality and streamline follow-up processes.
Dashboards and Metrics: Generating detailed reports for clear insights into A/R status and focused efforts on resolution.
Improved Collections and Reduced A/R Days: Clients typically experience a minimum 20% reduction in A/R days and improved collections by about 5-7%.
