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Coding Denial Management Solutions

Every medical practice experiences claim denials. Top performing practices have denial rates around 3%, while many other practices suffer denial rates anywhere from 10%, 20%, 30% or even more. These denied claims wreak havoc on an organizations financial performance therefore practices continuously look for opportunities that will allow them to improve.

EMR takes a systematic approach in evaluating your performance and learning why claims are being denied. Using that information, we determine what your practice will need to do differently in order to reduce denials, and increase the percentage of claims that are paid correctly, the first time

Diagnose:

Treat:

Manage:

 

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

Contact Enhanced Medical Revenue LLC today for more information.


 








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