Medforce Blog

What to Look for in Denial Management Software

May 16, 2017

Category: General

Unless you can build an effective and dependable denial management system internally that optimizes revenue cycle results, your healthcare organization risks losing hundreds of thousands of dollars or even more in net revenue each year. Additionally, pinpointing the primary reasons for denials is critical to successfully appealing them.

Although the suggested denial rate stands at just under four percent, some practices may see claims denied at a rate of between 10-20 percent, according to a Journal of AHIMA piece on claim denials. This is because organizations with higher denial rates rely exclusively on rely exclusively on anecdote and gut feel to identify issues or problems, which means personal preferences and biases can get in the way. The result: inaccurate analysis of data and continuing loss of revenue that could be avoided.

Eliminating Denials with Denial Management Software

With the capacity to precisely identify quantitative characteristics of rejected or denied claims, denial management software provides healthcare organizations with a fail-safe method of determining the root causes of denials. Once administrators are presented with this data, they can then implement changes essential to increasing revenue and decreasing rejections. Human error is often responsible for entering incorrect provider, patient, point of service and diagnostic information. Mismatching of codes and treatment also cause many claim denials/rejections, as well as if payers change policies between claims without directly updating the preparer.

Healthcare organizations can reduce and even eliminate denials by implementing denial management software capable of:

  • Importing ERNs manually or electronically
  • Storing patient-oriented Explanation of Benefits in each patient file
  • Creating redetermination cover sheets with attached supporting documents
  • Automatically emailing reports to designated personnel
  • Monitoring claims management in real-time
  • Preventing missed deadlines for filing denials
  • Identifying the source of work appeals and denials to increase revenue and cash flow
  • Parsing and resolving denials using detailed summary reports
  • Auditing quality, quantity and success of redeterminations and appeals
  • Monitoring and comparing effectiveness of job positions and employees in these positions

Simple medical billing software cannot reduce a healthcare organization's accounts receivable numbers. Manually examining thousands of claims is inefficient and only invites human error. Advanced denial management software can competently and seamlessly extract erroneous claims, compare individual claims against a comprehensive database of compliant guidelines and edit claims to prevent denials.

Healthcare revenue cycles consist of intricate sets of information-rich work systems that provide opportunities for enhancing efficiency. However, these data sets are almost always lost when manually managed by humans.

Medforce's RemitCenter solution for drastically reducing denials enables healthcare organizations to rely on machine intelligence to oversee important data and documentational aspects of each revenue cycle. By accurately capturing all data from initial patient intake to the final process of collecting on claims, your organization will consistently benefit from timely reimbursements, cost-efficient performance and nonexistent potentials for error. Additionally, once information is received by our data management software, it remains in the system and contributes to effortless report mining, data analytics and progressive business intelligence so that your organization can make the most informed decisions possible.

Don’t let mistakes hold your healthcare organization back -- learn more about how we can help.




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