Denial Management
Reduced Claim denials means a lot to the practice and tells about the effectiveness of the RCM process. At Charm, we take claim denial management seriously and steps are taken to reduce claim denials to achieve the industry denial average of 5%. This includes identifying mistakes prior to claim submission and to identify root cause of claim denials.
Claim Denial Management consists of the following steps:
- Identifying mistakes prior to claim submission
- Identifying root cause of denials
- Measuring the effectiveness of claim denial management process
As part of the claim denial management process, the following things are determined and appropriate actions are taken
- whether the denial can be corrected or require an appeal
- whether the denied items has to be written off.
To prevent claim denials, the following things are checked.
- Registration inaccuracies
- Ineligible for insurance
- Check for accuracy of the diagnosis code
- Incorrect modifiers
- Medical Necessity in the claim document
- Claims with no authorization or referral
