How do you reduce health insurance claim denials? Once you have reduced your denials, how do you further enrich your denials process when one does occur?
BHM Healthcare Solutions is a healthcare management consulting firm with many areas of expertise including denials management. Our services provide assistance in not only reducing medical denials, but providing Independent Review Organization services through our physician advisors and is accredited through URAC for these IRO services.
Reducing health insurance claim denials provides an opportunity to boost the bottom line and allow the organization to concentrate on other pressing financial issues.
- Complete a chart audit to determine the reasons for the denial issuance
- Analyze pre-service, concurrent and post-service review protocols.
- Assist in the implementation of effective tracking methods.
- Review both national and state regulations to determine if they are affecting your denial rates.
Our implementation process includes:
- Detailed strategy to target the denial and appeal process focusing upon implementing improvement within the organization
- Implement management protocols by introducing improved technology and implementing both tracking and benchmarking procedures
- Create methodology to manage the appeals process
- Implement training for utilization review and case management staff
- Assist in improving relationships and terms with payers
- Develop tracking methods to easily review causes for denials
Our prevention process includes:
- Review of managed care contracts that have an impact upon claim payments
- Prevention of physician reviews
- Training programs to address denial issues
- Assessment of billing processes that may delay the claims process
- Provide a methodology to focus on denials and appeals
- Provide training for utilization management and case management staff
- BHM has a state of the art physician review portal that automates many of the review processes.
- BHM is accredited by URAC for our IRO (independent review organization) services enhancing our credibility and dedication to quality.
- BHM has board certified physician reviewers with diverse specialties
Our physician advisor services encompass:
- Initial review
- Both standard and expedited reviews
- Concurrent reviews
- Appeal process
- Medical record review
- Clinical treatment shaping and consultations
- UM medical necessity review
- Physician advisor consultation
For more information on our denials management or physician advisor services, please visit our website https://www.bhmpc.com or call us at 1-888-831-1171. Please click on the following link to receive a free presentation on denials management http://www.bhmpc.com/denial-management-landing-page/.