A GUIDE TO DENIAL MANAGEMENT
What is Denial Management?
Denial management is described as a process of pointing out problems to mitigate the denials of insurance claims in the medical billing for behavioral health billing services sector. Denials can occur when an insurance company refuses to pay for medical expenses or pays a part of it. They are many types of denials, admission notification, lack of medical necessity and retro active termination. While some denials can’t be avoided some can be seen with a proactive approach, The main aim of this approach is to improve revenue cycle efficiency, reduce financial loss and maximize reimbursement.
Common Reasons for denial
A claim denial can occur because of
- Lack of Medical Necessity
- Admission Notification Denials
- Staff lacking training on ASAM and LOCUS Criteria and inability to articulate symptomology.
- Modification in coding and billing,
A claim can be denied for many reasons as stated above, but typically denials are due to client’s not meeting medical necessity or failure to meeting precertification requirements. Most insurance companies require admission notification within 24-48 hours of admit, but some carriers such as Regence, UHC, and Aetna require strict notification requirements for specific levels of care. Lack of medical necessity is another major reason for denials. Medical necessity is typical reviewed weekly or bi-weekly depending on the level of care. The higher the level of care, the more frequent the reviews. How does a facility avoid lack of medical necessity review? Translation of Key Symptoms! ASAM and LOCUS criteria use a framework to determine appropriate level of care. Ascension Billing educates it client’s on ASAM and LOCUS LOC’s to ensure your charts meet compliance and regulatory requirements.
How does it work?
A solution to denial management in substance abuse and mental health is in the following steps:
- Identification (Find out a reason for denial)
- Monitoring (Analyze denied claim root cause to avoid the same problem in future)
- Managing (Resolve the problem by rectifying it and then resubmit it.
- Prevention (Develop a system to prevent denials)
Strategies to Resolve a denial
To rectify the problem related to insurance claim denials in substance abuse and mental health sector, the following are the approaches for denial management:
- Root Cause analysis
Determining the main cause of claim denial by examining each step of billing and documentation. It will help to make it easier to identify errors and head up to solutions
- Clinical information improvement
Ensuring the Billing process of patients’ clinical records. Before billing claims, all services must be verified.
- Verification process
Collecting relevant and correct patient information before delivering services. It guarantees that services are in line with the patient’s coverage and helps avoid denials.
- Appeals
Sending appeals for denial claims, adding letters to support the claims and rectifying the invalid codes.
- Resubmission
Resubmitting claims after making revisions can result in reimbursement.
- Advanced Technology
Billing and coding can be made easier by advanced software. Ascension Billing utilizes cutting edge technology for claims submission, data management and maintain strict HIPAA compliance. Creating an efficient workplace creates efficient employees. At Ascension Billing, our employees come first! Creating a workflow that is error-free and provides constant productivity is our mission!
Organizations can enhance cash flow, save administrative costs, and guarantee speedy and reliable reimbursement for mental health billing services through efficient denial management techniques. All of these benefits will eventually support the long-term viability and financial stability of healthcare facilities.
RCM in denial management
RCM is the abbreviation of Revenue Cycle management in behavioral health billing or substance abuse billing. Revenue Cycle Management describes the financial procedure used by the healthcare sector to oversee every step of the patient’s billing. From the first pre-screen or consultation to the last payment. Revenue Cycle Management consist of various steps:
- Verification Of Benefits
- Pre-screen’s and Medical Necessity Determination
- Admission and Financial Documention
- Utilization Review/ Precertification / Concurrent Review
- Coding and Billing
- Submitting Claims
- Payment posting
- Following up on claims that are denied or unpaid.
The aim of RCM is to stop or minimize denial by taking sensible measures such as:
- Precise documentation and ensuring symptomology is translated
- Pre-authorization procedures and advanced notification of specific carriers with limitations
- Employee education and training on ASAM and LOCUS Criteria
- Technological Integration / Programming Transparency
It also involves reviewing denied claims and analyzing rejection trends to improve overall financial outcomes in medical billing for behavioral health services.
What Makes Ascension Billing the Best?
Ascension Billing has professionals with extensive training and experience who put in a lot of effort to know the emerging carrier changes. To guarantee that customers receive the best services, Ascension Billing use time-blocking techniques that are well-suited to maximize profits and client satisfaction and allow access to real time data during each step each step of the billing process. We have reduced the amount of tasks it takes to complete the billing process translating into less work for our employees, so they can focus on what matters most, treating their patients.
Ascension Billing Services
Ascension Billing provides a variety of services in mental health and substance abuse medical billing. We identify problems in Revenue cycle management, find the root cause in reporting, rectify the problem and then review the claim before submission to avoid future denial. The main target of Ascension billing is to reduce the denial percentage and to manage a denial effectively to fill the gaps in revenue flow.
Have you considered outsourcing but are hesitant about it? Are you trying to outsource the management of your substance abuse and mental health medical billing? Ascension Billing has extensive experience in managing denial. We are dedicated to providing you with excellent services that are beyond your expectations. Reach out to us right away!
References
- https://www.devry.edu/blog/denial-management.html#:~:text=Denial%20management%20in%20medical%20billing,to%20optimize%20providers’%20cash%20flow.
- https://go.gale.com/ps/i.do?id=GALE%7CA90317285&sid=googleScholar&v=2.1&it=r&linkaccess=abs&issn=07350732&p=AONE&sw=w&userGroupName=anon%7E7abef4f4&aty=open-web-entry
- https://www.plutushealthinc.com/post/denial-management-in-revenue-cycle-management-workflows-strategies-and-automation#:~:text=A%20denial%20means%20that%20the,financial%20transactions%20for%20patient%20services.
- https://www.mdclarity.com/blog/denial-management
- https://advantumhealth.com/best-practices-revenue-cycle-management/
- http://www.ascensionbilling.com
- https://www.asam.org/asam-criteria/about-the-asam-criteria
DENIAL MANAGEMENT
What is Denial Management?
Denial management is described as a process of pointing out problems to mitigate the denials of insurance claims in the medical billing for behavioral health billing services sector. Denials can occur when an insurance company refuses to pay for medical expenses or pays a part of it. They are many types of denials, admission notification, lack of medical necessity and retro active termination. While some denials can’t be avoided some can be seen with a proactive approach, The main aim of this approach is to improve revenue cycle efficiency, reduce financial loss and maximize reimbursement.
Reasons for denial
A claim denial can occur because of
- Lack of Medical Necessity
- Admission Notification Denials
- Staff lacking training on ASAM and LOCUS Criteria and inability to articulate symptomology.
- Modification in coding and billing,
How does it work?
A solution to denial management in substance abuse and mental health is in the following steps:
- Identification (Find out a reason for denial)
- Monitoring (Analyze denied claim root cause to avoid the same problem in future)
- Managing (Resolve the problem by rectifying it and then resubmit it.
- Prevention (Develop a system to prevent denials)
Strategies to Resolve a denial
To rectify the problem related to insurance claim denials in substance abuse and mental health sector, the following are the approaches for denial management:
- Root Cause analysis
Determining the main cause of claim denial by examining each step of billing and documentation. It will help to make it easier to identify errors and head up to solutions
- Clinical information improvement
Ensuring the Billing process of patients’ clinical records. Before billing claims, all services must be verified.
- Verification process
Collecting relevant and correct patient information before delivering services. It guarantees that services are in line with the patient’s coverage and helps avoid denials.
- Appeals
Sending appeals for denial claims, adding letters to support the claims and rectifying the invalid codes.
- Resubmission
Resubmitting claims after making revisions can result in reimbursement.
- Advanced Technology
Billing and coding can be made easier by advanced software. Ascension Billing utilizes cutting edge technology for claims submission, data management and maintain strict HIPAA compliance. Creating an efficient workplace creates efficient employees. At Ascension Billing, our employees come first! Creating a workflow that is error-free and provides constant productivity is our mission!
Organizations can enhance cash flow, save administrative costs, and guarantee speedy and reliable reimbursement for mental health billing services through efficient denial management techniques. All of these benefits will eventually support the long-term viability and financial stability of healthcare facilities.
RCM in denial management
RCM is the abbreviation of Revenue Cycle management in behavioral health billing or substance abuse billing. Revenue Cycle Management describes the financial procedure used by the healthcare sector to oversee every step of the patient’s billing. From the first pre-screen or consultation to the last payment. Revenue Cycle Management consist of various steps:
- Verification Of Benefits
- Pre-screen’s and Medical Necessity Determination
- Admission and Financial Documention
- Utilization Review/ Precertification / Concurrent Review
- Coding and Billing
- Submitting Claims
- Payment posting
- Following up on claims that are denied or unpaid.
The aim of RCM is to stop or minimize denial by taking sensible measures such as:
- Precise documentation and ensuring symptomology is translated
- Pre-authorization procedures
- Employee education and training
- Technological integration
It also involves reviewing denied claims and analyzing rejection trends to improve overall financial outcomes in medical billing.
What Makes Ascension Billing the Best?
Ascension Billing has professionals with extensive training and experience who put in a lot of effort to know the emerging trends in the market. To guarantee that customers receive the best services, Ascension Billing use time-blocking techniques that are well-suited to maximize profits and client satisfaction and allow access to real time data during each step each step of the billing process.
Ascension Billing Services
Ascension Billing provides a variety of services in mental health and substance abuse medical billing. We identify problems in RCM Revenue cycle management, find the root cause in reporting, rectify the problem and then review the claim before submission to avoid future denial. The main target of Ascension billing is to reduce the denial percentage and to manage a denial effectively to fill the gaps in revenue flow.
Have you considered outsourcing but are hesitant about it? Are you trying to outsource the management of your substance abuse and mental health medical billing? Ascension Billing has extensive experience in managing denial. We are dedicated to providing you with excellent services that are beyond your expectations. Reach out to us right away!
References
- https://www.devry.edu/blog/denial-management.html#:~:text=Denial%20management%20in%20medical%20billing,to%20optimize%20providers’%20cash%20flow.
- https://go.gale.com/ps/i.do?id=GALE%7CA90317285&sid=googleScholar&v=2.1&it=r&linkaccess=abs&issn=07350732&p=AONE&sw=w&userGroupName=anon%7E7abef4f4&aty=open-web-entry
- https://www.plutushealthinc.com/post/denial-management-in-revenue-cycle-management-workflows-strategies-and-automation#:~:text=A%20denial%20means%20that%20the,financial%20transactions%20for%20patient%20services.
- https://www.mdclarity.com/blog/denial-management
- https://advantumhealth.com/best-practices-revenue-cycle-management/
- http://www.ascensionbilling.com
- https://www.asam.org/asam-criteria/about-the-asam-criteria
