6 Effective Tips to Improve Denial Management of Medical Practices


Indeed health care services and medical practices are all about caring for the patients and helping them regain their health. However, just like all businesses, a medical practice too needs to generate enough revenues to manage the smooth sailing of its operations.

The major part of the revenues for a medical practice comes from the medical claims that are submitted to the insurance companies. But, it has often been seen that most practices lose out on a large amount of money due to the denial of medical claims. This can have serious repercussions on the revenue generation, which is why experts believe that all medical practices should have a perfect denial management strategy in place.

Here are some expert tips that can prove handy in improving the denial management function for all medical practices.

Track the Underlying Cause:

Claims are not denied unless there is an important underlying reason. This could often be because the patients may not be well aware of the whole claims mechanism. At other times, it could be because of the medical staff may have overlooked a regulation or have been unaware of a sudden change. Understanding the underlying reason for claims denial is what is required in order to begin the process of an efficient healthcare denial management.

Automation and Streamlining of Denials:

It has often been cited that medical practices tend to lose track of their medical claim denials which can lead to the piling up of denied claims. This makes it difficult for the staff to keep track of the denials and thus, the practice may actually end up losing out on a lot of money. In order to avoid this, medical practices should automate their claims department, such that the whole denials management process can be streamlined. With this organized approach, it becomes easier to keep track of the denied claims and resubmit the requests.

Weekly Analysis and Resubmissions:

Medical practices should ensure that the work flow is efficient enough such that all the denied claims are analyzed, corrected and resubmitted within the week. Prompt resubmissions ensure that the denied claims do not pile up while also leading to prompt and timely collections.

Tracking the Progress:

Streamlining the claims process and regular submission of denials is not enough. Medical practices need to stay at the top of things and track the progress of the whole system. This will help them to identify what seems to be working for them and what areas should be rectified.

Identifying the Trends:

Not all the claims are denied. Most often than not, denials of medical practices follow a trend. Tracking this trend will actually help the practices to identify the underlying causes which can then be rectified. It is important that this is not overlooked as ignoring these trends can actually prove to be a serious threat to revenues.

Keeping the Deadlines:

There could be a number of reasons for medical claims denial. However, one of the worst reasons of these is missing the deadline. All medical practices should bring in a work flow system where the staff is trained to complete all the required paper work and submit the claims within the stipulated deadline.

Offering incentives to staff members based on their collections is also a great way to motivate the workers and improve the healthcare denial management process. A lot of medical practices these days have also started outsourcing medical billing process as this too ensures more collections. With an effective management of medical claim denials, practices can look forward to improved revenues.