Denial Management

Denials and Appeals

Find the root cause. Address issues. Get paid. Focus on denial prevention.

Denial Management Services

Denial Management Services

What is Denial Management in Healthcare?

Denial management is often confused with Rejection Management. Rejected Claims are claims that have not made it to the payer’s adjudication system on account of errors. The billers must correct and resubmit these claims. Denied Claims, on the other hand, are claims that a payer has adjudicated and denied the payment.

Healthcare organizations should be concerned about both rejected claims and denied claims. The claims rejection management process provides an understanding of the claim’s issues and an opportunity to correct the problems. Denied Claims represent lost revenue or delayed revenue (if the claim gets paid after appeals).

To successfully appeal denied claims, the billers must perform a root-cause analysis, take actions to correct the identifies issues, and file an appeal with the payer. To thrive, a healthcare organization must continuously address the front-end processes’ problems to prevent denials from recurring in the future.

5/4

Medical Billing Wholesalers

Health Care BPO

12 years experience

What is Denial Management in Healthcare?

 Denial management is often confused with Rejection Management. Rejected Claims are claims that have not made it to the payer’s adjudication system on account of errors. The billers must correct and resubmit these claims. Denied Claims, on the other hand, are claims that a payer has adjudicated and denied the payment.

Healthcare organizations should be concerned about both rejected claims and denied claims. The claims rejection management process provides an understanding of the claim’s issues and an opportunity to correct the problems. Denied Claims represent lost revenue or delayed revenue (if the claim gets paid after appeals).

To successfully appeal denied claims, the billers must perform a root-cause analysis, take actions to correct the identifies issues, and file an appeal with the payer. To thrive, a healthcare organization must continuously address the front-end processes’ problems to prevent denials from recurring in the future.

Our Denial Management Service Offering

Medical Billing Wholesalers’ denial management team has seasoned professionals who:

We understand that each denial case is unique. We correct invalid or incorrect medical codes, provide supporting clinical documentation, appeal any prior authorization denials, understand any genuine denial cases to pass the responsibility to patients, and follow-up effectively. We re-validate all clinical information before re-submission.

As an extended billing office, we work with you to analyze your denied claims and reduce denial % over time.

Filing Appeals

We analyze denial reasons, prepare appeal letters, and refile the claims by attaching clinical documentation and submit the claims via fax appeals in a payer-specific format.

Reducing Denials Through Analytics

Different component processes within the revenue cycle chain can result in claim denials. Often, denial issues are practice-specific or facility-specific. We understand the trends in claim denials and launch an iterative process to reduce them based on specific causes.

Florida Based Medical Billing Company

“I really appreciate the reporting process followed by the Medical Billing Wholesalers’ team. The report consisting of the TOP 10 reasons for denials and rejection is really valuable & helps to control the practice’s rejection and denial rates.”

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Our users are Happy & Healthy

Proficient FTE Handling

Very happy with how things have been going and appreciate all that the team and you guys have done for us.
V.P.
V.P.
Michigan-based Autism Services Provider

Behavioral Collections Up by 50%

Our collections for behavioral health services have gone up by 50% thanks to your team’s expertise. We couldn’t have done it without you. Your work has truly been transformative for our practice.
Dr. M.J.
Dr. M.J.
Phoenix, Arizona-based Behavioral Health Center

Credentialing Simplified

Honestly, credentialing was a nightmare before we started working with you. Now it’s so smooth—we can onboard behavioral health providers without breaking a sweat. Thanks for making it easy.
K. W.
K. W.
Massachusetts-based Behavioral Health Center

Lightning-Fast Support

Your team’s responsiveness is remarkable. Every billing issue we’ve raised has been resolved promptly, often within 24 hours. It’s rare to find a partner who’s this reliable.
Dr. H.N.
Dr. H.N.
Denver, Colorado-based Healthcare Group

Proactive AR Management

Kudos to MBW! Outstanding accounts are being handled proactively by your AR callers. We’ve seen a clear improvement in payment timelines.
Dr. S.L.
Dr. S.L.
Los Angeles-based Specialty Practice

Finally Stress-Free

Switching from my old billing company to Medical Billing Wholesalers was the best decision. They handle cardiology billing with precision and care. No more denials or billing headaches.
Dr. A.B.
Dr. A.B.
Boston, Massachusetts

Cardiology Denials Cut by 35%

I gotta say, you’ve really helped us turn things around. Cardiology billing used to be a mess, but now denials are down by 35%, and I don’t lose sleep over it anymore. Appreciate y’all.
Dr. T.L.
Dr. T.L.
Orlando, Florida-based Clinic

Healthcare partnerships

Benefits of Our Denial Management Services

Improved Revenue Recovery:

Our Denial Management Services are at the forefront of recovering revenue from denied claims. We diligently work to identify, address, and appeal claim denials, significantly boosting your revenue recovery rates.

By thoroughly analyzing the reasons behind claim denials, we help in refining your billing practices. This proactive approach not only reduces future denials but also minimizes revenue loss and streamlines your billing processes.

Embrace efficiency with our services. We automate and optimize various tasks within the revenue cycle, minimizing manual errors and maximizing operational productivity.

Our approach is grounded in analytics. By examining denial patterns, we provide actionable insights that help in making informed decisions, improving your overall billing strategy.

By partnering with us, you’re not just improving your revenue cycle efficiency; you’re also choosing a cost-effective solution. Our Denial Management Services lead to significant cost savings by reducing denials and optimizing your overall revenue cycle.

Navigating the complexities of healthcare regulations can be daunting. Our services ensure that your claims are compliant with current regulations, reducing the risk of penalties and ensuring adherence to industry standards.

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We go beyond denial management and shift focus to denial prevention. Contact us to learn how we can transform your revenue cycle management and pave the way for a more financially secure future.








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