Denial & Rejection Management Services

Denial and Rejection Management Services

Claim denials affect every medical practice but, what distinguishes efficient healthcare businesses from the rest is how they manage denials.

Denial and Rejection Management Services

Rejection management can sometimes be confused with denial management. Rejected claims are those that did not make it through the payer’s adjudication procedure due to errors. These claims must be corrected and resubmitted. Rejected claims, on the other hand, are claims that have been adjudicated by a payer and have been denied payment.

Both rejected and denied claims ought to be a source of concern for healthcare providers. The claims rejection management process allows for a better understanding of the claim’s issues as well as the potential to fix them. Denied claims reflect revenue that has been lost or delayed (if the claim gets paid after appeals). Professionals must perform a root-cause analysis, take steps to fix the identified errors, and then file an appeal with the payer to successfully get paid for refused claims. To thrive, a healthcare organization must constantly fix the issues with the front-end systems in order to prevent further denials and rejections.

Minimize Denials & Rejections

What Makes Us Unique?

Our Denial and Rejection Management Services set us apart from our competitors. Other AR Recovery Services concentrate on obtaining “easy money,” or revenue that can be gained just by including the initial billing technique. This method may increase the billing provider’s profit margins, but it does not improve the practice’s bottom line.

Our denial management services are designed to help you recover those challenging claims that have gone unpaid for a long time. We offer accounts receivable recovery services as a stand-alone option rather than as part of a revenue cycle management package, unlike many other medical billing recovery companies. We don’t believe in a one-size-fits-all approach to AR management and instead seek to customize our services to your specific needs.

Specialized Knowledge And Prompt Implementation

Many physicians and facilities fail to handle and resubmit denied or rejected claims due to a lack of time and professional knowledge in the denial/rejection reimbursement arena. Denial and rejection management necessitates specialized knowledge and prompt implementation. Therefore, you need diligent and qualified personnel who can handle such issues effectively, successfully, and on schedule.

Staff Training Initiatives

MJM & SONS is staffed with the finest medical coding and billing specialists, who have been hand-picked for their competence and experience in the field. These experts are perpetually enrolled in recurring staff education initiatives to ensure that they have the most up-to-date understanding of billing and coding guidelines. In general, insurance companies have a pre-approved list of procedures or diagnosis combinations that they will pay for. We maintain an up-to-date database of such allowed combinations by various insurance carriers. Our highly acclaimed coders make certain that the highest paid and most accepted combination of procedure and diagnosis codes is being utilized to ensure maximum payment and rapid clearance.

Tracking

In the situation that a claim is rejected, we provide extensive assistance in determining the reasons that led to the rejection and how to resolve them. We also take on the additional obligation of investigating the causes of rejections in order to prevent the recurrence of errors that lead to rejections. In most cases, the in-house personnel fail to successfully pursue denials with payers, and the claims are generally written off. All of this may be avoided with the help of a knowledgeable and proactive denial and rejection management team that works together with trained coders and other billing specialists to handle the issue as quickly as feasible and to the fullest degree possible. At MJM &SONS, we use a sophisticated tracking system to guarantee that refused or rejected claims are followed up on. We implement an intensive follow-up approach to guarantee that your collections are on track by monitoring the claims submission and settlement phases.

Reasons & Solution

It might be an out-of-place modifier or a combination of codes not allowed under the CCI modifications, or it could be because adequate pre-authorization for the procedure, as mandated by the patient’s carrier, was not obtained at the time of the patient’s initial visit. The reasons can be any multiple of a number, but the answer is only one – MJM & SONS.

Denials And Rejections Are Common For A Variety Of Reasons

The claim was sent to the incorrect contractor or payee.
The patient ID is incorrect.
There’s another primary insurance policy.
The name or date of birth of the patient does not match the record.
The primary payer’s coordination of benefits needs to be updated.
The NPI of the referring physician is invalid.
The zip code for the location where the service was rendered is invalid.
The Procedure Code for the date of service is incorrect.
The patient’s date of birth is incorrect.
There is no prior authorization.
The modifier used is incompatible with the procedure code, or a needed modifier is missing.
The patient’s current benefits do not cover the services provided.
The provider may be out of network.
Rendered services may not be covered because the payer does not consider certain treatments to be medically necessary.

Every denial and/or rejection must be dealt with appropriately and promptly. Different steps are required depending on the cause. The denial and rejection management staff must be able to understand the reason for the rejection/denial, as well as be up to date on payer policies and procedures.