Coding Denial Management Solutions

The first step towards improvement is to know why claims are being denied.  Know your numbers!

1. Measure the number of claims that are denied
   1. Total claims filed to a payor 
   2. Number of denied line items
   3. Calculate percentage denied line items (Number divided by Total claims)
2. Calculate claims and dollars rate
   1. Total collars remitted minus total dollars paid divided by total dollars remitted
3. Categorize denials
   1. Duplicate
   2. Medical Necessity
   3. Documentation
   4.  Bundled/Non-Covered
   5. Experimental

Once claims are categorized by Denial Reasons, you can begin to identify the root-cause of the denials, and immediately take actions.

1. Create front end edits
2. Educate Providers & Coders
3. Develop Coding Tip Sheets for complex services or special payor nuances
4. Create tracking, reporting and trending processes which will allow your practice to measure its performance over time

Having comprehensive data will allow you to focus on the most frequent denials, by service line, provider, or type of service performed.

Leveraging EMR will:

• Reduce the overall management burden while retaining control of strategic decision making
• Eliminate staffing problems
• Get access to specialized skills