Denial Management & Prevention

Denial’s prevention is a fundamental requirement for every healthcare organisation to accelerate.

Process of Managing Denials

Performing root cause analysis for reasons of rejections

Categorising the various causes of rejections

Classification of rejections as per their severity level

Identify and complete gaps in the claims process

Timely resubmission of claims to the payer & A-R system

Why keep denials in control

As a well-known fact, Denial rates are directly proportional to the level of efficiency & quality of outcomes at all RCM stages. Knowing that most of denied claims are preventable, it is important to understand how to analyse these denials & design prophylactic protocol to prevent denials before they happen.

Denial’s prevention remains a fundamental requirement for every healthcare organisation that aims for best-practice model, streamlining cash flow, reducing rejections and achieve enduring financial success

Preventing Denials

Create regulatory rejection KPIs for all claim payers.

Creating a payer specific rejection KPI.

Update of KPIs for newly arising rejection trend per payer.

Use technology for continuous processes improvement.

Apply intelligent predictive analytics wherever possible.

Enhance the level of performance of RCM units which are the root cause of rejections

Training to various RCM teams taking care of rejections & empower them for prevention.

Respect timelines for resubmission. Timely resubmission is critical as per insurance protocols.

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