Reimbursements from insurance payers form the backbone of a healthcare provider’s revenue stream. After having provided medical services to a patient, the provider fills out the necessary information and sends a claim over to the payer. The payer processes it, and if everything is in order, pays the provider. But not all claims are accepted. Some are rejected even before they make it to processing, but many others are denied. Denied claims cost providers dearly and it becomes necessary to address the causes of denials.
In light of this, solutions for healthcare denial management software processes have become extremely important for small clinics with a few physicians, as well as large hospitals. Whenever a claim is denied, there is a process of appealing the denial. This again costs the providers time and money. It is important for healthcare denial management software to involve functionality that streamlines the activities in the denial management and appeals workflow.
When planning to invest in a healthcare denials management solution, it is important to consider the features of that solution. Let’s look at some of the important functions that a medical claims denial management platform ought to have –
- Analytics
As is the case with just about every industry, analytics solutions help assess business operations and highlight patterns that might provide insights to users. The same holds good for healthcare denial management solutions workflows. There are various reasons why a claim might get denied. It could be mistakes in filling the claims, missing codes or authorizations, or if the treatment might not be considered necessary. Whatever it might be, it helps to know why claims from a provider get denied.
This knowledge helps them implement measures to ensure that the workflow around claims is free of any errors that might get it denied. To sum it up, it helps providers learn what they were doing wrong and correct the mistakes.
- Medical Clearing House
This is yet another must-have when implementing a hospital denials management solution. As mentioned above, there are multiple reasons why a claim might get denied. However, an in-built medical clearinghouse within a solution for denials management in healthcare helps scrub the claims before they are sent to payers. This is done to validate the electronic claims according to the rules of specific insurance payers. In addition to scrubbing out the claims for any minor errors, this feature within a medical revenue cycle denial management software also flags down any claims that have a high probability of being denied or rejected.
This feature is extremely important to resolve problems in the claims before they are sent to payers. Furthermore, a medical clearinghouse feature in a denials management software also offers a report of all the errors in each claim.
- Automated Appeals
Appealing a denied claim is something that most providers would rather avoid doing, but need to do nonetheless. Medical billing denials and solutions with the function of automated appeals streamline the processes and activities involved in appealing claim denials. It helps providers save time, money, and resources that can be diverted to caring for patients. A digital solution that automates this part of denials management directly impacts providers’ revenue cycles.
If you’re looking to invest in a denial management solution, ensure that you get these features. Although the features of such solutions might vary from company to company, the aforementioned features are key for efficient denial management.
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