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Denial Management

For most of the medical insurance payers, the rule is “Doubt it?  Deny it”. It’s a popular notion that medical practices are too busy to correct the denied claims and resubmit as appeals to insurance companies. Which is in the benefit of insurance companies as it saves them considerable amount of money. Outsourcing your denial management to a medical billing company can help you tackle these denials and improve inflows. Denial management services of Simplexmed can help your practice reduce your claim denials as low as five percent.

It is important to evaluate the root cause of denials and devise a strategy to eradicate it. Medical billing company can help practices and physicians design that plan of denial management to minimize the denials and increase the circumstances of you getting paid.

A simple plan to follow for denial management is:

Keep a track of how many times you have to deal with claim denials

This requires knowledge of your billing and practice management system. Two methods can be used to post claims. Depending on the type of system used. Most practices prefer to use automated system to post claim electronically, whereas practices can also use the manual system of posting claims. In case of manual system user has to manually enter denied claims i.e. zero payment remittances.

Denial Management

Evaluate the root cause of denial.

To reduce such claim denials, you have to find out the root cause of the claim denial. Nearly half of all claims (48 percent) were pended due to the submission of duplicate claims (35 percent), lack of complete information or other information needed to justify the claim (12 percent), or invalid codes (1 percent). Twenty-four percent of pended claims were due to coverage issues, including no coverage based on date of service (8 percent), non-covered or non-network benefit or service (7 percent), coordination of benefits (5 percent), or coverage determination (4 percent). Other or miscellaneous reasons were the cause of the remaining 28 percent of pending claims. Once you find out the root cause of claim, then on the basis of common loopholes categorize these claim denials and finally deploy action plan to eradicate each cause and correct the claims to resubmit the appeals.Having comprehensive details about your claim denials will allow you to focus on the most frequent reasons of denials and in the most efficient way because you will know if it is payer, location, specialty or provider specific and you can use only the resources necessary to reduce your claim denials and increase your collection performance.

Monitor your practice’s progress over the time to measure your performance.

Denial data is a “roadmap for change” in my medical practice. Practices that follow an actionable plan of denial reporting, are always on a safe side. Because it aides them to make necessary changes in their practices and avoid previous mistakes to boost claim acceptance in the future.These are the few basics of denial management Simplexmed can take care of for you. Our services will help you get paid faster and boost the claim acceptance rate by eradicating the root cause of the claim denial.
The main aim of follow-up is to obtain claims status, appeals status, and reason for rejection of claim in case of denial.

Revenue Optimizer (RO)

Revenue Optimizer (RO)

We will optimize your revenue through practice web-portal development and online marketing, payout analysis.

Claim Preparation

Claim Preparation

Error-free claim preparation and validation based on information provided by the practice

Elec/Paper Claim Submission

Elec/Paper Claim Submission

Claims can be submitted either electronically or via paper mail where required

credentialing services

Credentialing Services

When you need essential credentialing data, and you need it immediately, Simplexmed is here to help you

Elec Data Interchange (EDI)

Elec Data Interchange (EDI)

End-to-end encrypted data transfer between payers and providers along with electronic fund transfer (EFT)

Patient Service

Patient Services

Patient calls, itemized electronic and paper statements, and toll-free patient helpdesk

Reporting

Reporting

Get all the relevant reports when you need them. Easy access to all reports with a single click

Coding Services

Provide services in implementation of ICD-10 & CPT codes, help in diagnosis and procedures

Payment Posting

Payment Posting

Faster and accurate claim submission results in timely payment posting to the providers

A/R Management

A/R Management

Timely follow-up with the payers to assure timely payments to the provider

Denial Management

Denial Management

Minimal denials with active web based charge entry system

Meaningful Use

Meaningful use: is using (MU certified) electronic health record (EHR) technology