Denial Management

According to Journal of AHIMA, denial rates are on the rise, increasing by more than 20% over the last five years. 

Denied and/or rejected claims pose significant financial challenges for most all healthcare providers today. These claims are commonly missing important information like establishment of medical necessity, clinical validity, appropriate diagnosis/procedures codes or pre- certifications/authorizations.  Some claims are not filed in a timely manner, while others may have been filled more than once.   

Many providers lack the internal resources to appropriately and successfully appeal denials, so it is not surprising that many denials are upheld by the payer or never even appealed. This results in lost revenue and compromised data integrity. While understanding the reason for denials is important, identifying the root causes for the denials is critical in reducing future liabilities.