5 Steps for a Strong Denials Management Process

How much time does it take your practice to manage claims denials? It’s probably much more than you would like to spend.  

Of all efforts you put toward ensuring your practice is financially successful, managing denials may be the most critical step.

5 tips for a strong denials management process

Having a strong denials management process can help you recoup significant revenue that would otherwise be lost, as well as identify trends in errors, so you can correct your processes to prevent future denials.

1. Calculate your current denials rate

Divide the number of denied claims from a payer by the total number of claims submitted to that payer. Multiply this by 100 to determine your denial rate and establish a benchmark.‍

2. Track historical denials and payments

Review past claims and remit data to see when you’ve been paid correctly and when your claim was denied. For each denial, assess the reason, the dollar amount and the appeal status.

3. Identify trends

Categorize your denials, looking for patterns that will help you prevent future denials. Also, isolate denial reason codes that historically have been the shortest appeal resolution time in order to get paid quicker. ‍

4. Focus on claims with the highest probability of getting paid

Concentrate your attention on the denials that will quickly generate revenue with easy fixes, such as filling in missing information or revising an incorrect code. Weigh whether claims with eligibility issues or improperly documented services are worth readdressing. ‍

5. Update process to prevent denials

By uncovering your most common causes of denials, your staff can look at changing existing or creating new processes that will help prevent future denials. For example, if many of your denials involve patient eligibility, checking each patient’s insurance both before and on the day of service will help with claim accuracy.

A good denial management plan will help optimize your finances. For ChiroTouch customers, CTProClear is the convenient solution.

‍ChiroTouch provides this information with the understanding that authors or speakers are not experts in finance, regulatory policy or law. ChiroTouch shares this information to the best of our knowledge and experience. The information is subject to change as the COVID-19 crisis evolves.