Understanding Denial Management
The methodical process of determining the underlying reasons behind claim denials, putting remedial measures in place, and averting more denials is known as denial management. Reviewing rejected claims, contesting erroneous rejections, and streamlining billing procedures to cut down on errors are all part of the procedure.
Common Causes of Claim Denials
- Incomplete or Incorrect Information – Missing or inaccurate patient details, diagnosis codes, or provider information.
- Lack of Pre-Authorization – Certain treatments and procedures require prior approval from insurance providers.
- Duplicate Claims – Submitting identical claims for the same service can lead to automatic rejections.
- Medical Necessity Issues – Claims may be denied if the payer deems a service unnecessary or unproven.
- Timely Filing Issues – Claims submitted past the insurer’s deadline may be denied.
- Out-of-Network Provider Issues – Claims may be rejected if the provider is not in the patient’s insurance network.
Why Choose PSP for Denial Management?
Knowledge of the Healthcare Revenue Cycle: Our group has a great deal of experience managing denied claims and streamlining the reimbursement procedure.
Improved Cash Flow & Revenue Recovery: Our calculated strategy reduces monetary losses brought on by denials.
Faster Resolution Times: We move swiftly to settle rejected claims and effectively collect money.
Compliance & Accuracy: Our denial management techniques comply with payer and regulatory regulations.