Important Steps of Managing Claim Denials

How does denial management function? It is a question that comes to mind for every healthcare provider. However, the claim denial management works in simply four simple steps. It starts with the identification of the root cause of the denial management, followed by management practices, monitoring, and prevention of denial management.

Identification

The primary function of denial management is to identify the root cause of claim denials. In the discipline of medical billing and coding, these denial claims are often represented by the code CARC or Claim Adjustment Reason Codes. Medical billing and coding professionals can quickly understand the meaning of these codes, and they can make future decisions based on these codes. This is the first step of the denial management function.

Management

Management is the second important part of the denial management function in which all practices and efforts are implemented that can help in reducing claim denials. It is the responsibility of denial management experts to create action plans and steps for reserving the denied claims that can help in securing claim reimbursement.

Monitoring

Monitoring is the third important discipline of denial management function. At this stage, the denial management professionals organize all denial records and perform a comprehensive audit process. This will provide them insight into a particular denial. In doing so, they can take assistance from technology and other team members that will help them to provide an optimum level of monitoring that will ultimately help in reducing claims denials. 
Read More....