Health insurance denials could be causing your organization to lose a significant amount of revenue each year. We can help your organization optimize profitability with our denial management process, which has lead our clients to see a dramatic reduction in health insurance denials and a measurably improved bottom line.
Why denial management is essential to a health care organization
Industry studies indicate that approximately 25-30% of health care claims are rejected or denied. This results in millions of dollars of lost revenue each year for health care organizations. The majority of these losses can be avoided by implementing our unique denial management process.
Our unique approach:
- BHM’s CORE Principles for denial reduction
- Communication
- Organization
- Recording
- Education
Analysis and Assessment – detailed assessment results in comprehensive understanding of your organizations health insurance denials.
- We will provide a comprehensive evaluation of processes, source of denials and reason
- Analysis of pre-service, concurrent and post-service review protocols
- If effective tracking methods have not been implemented for your organization we will help you to develop and implement these.
- We will thoroughly review denied charts to determine causation
- We will review local and national regulations to help determine how they are effecting your organization and denial rates
Implementation – Smooth process to quickly begin to reduce or eliminate denied insurance claims which we can help your organization
implement step by step
- We will provide a detailed strategy to target the denial and appeal process focusing on implementing improvement within your organization
- BHM will make handling denied claims manageable by inserting management protocols, introducing improved technology and implementing tracking and benchmarking procedures
- We will create methodology for your organization to easily manage the appeals process
- Implementation of targeted training for the utilization review and case management staff as well as clinical staff that will be targeted to addressing specific issues within your organization
- We will work with you to improve relationships and terms with payers to ensure that your organization maintains a low denial rate into the future.
- Development of overall tracking methods to help you determine the cause of denials
Prevention – we focus on procedures that can be implemented to prevent insurance claim denials from occurring.
- Review of managed care contracts that have a bearing on claims payment
- Prevention of physician reviews and thus denials
- Training programs to address specific denial issues
- Assessment of billing practices that may delay the claims process
- Providing a methodology to focus on denials and appeals
- Providing training for the utilization review and case management staff
Our comprehensive modules include:
- Reasons for denial insurance claim
- Denial appeal status
- Provider and payer responses to authorizations
- Provider and payer responses to concurrent insurance claim denials
- Information regarding physicians and departments involved in the insurance denial process
- Case-management notes
- Level of care determination
- Revenue which is lost or at risk
