Key factors to consider while choosing a medical billing services company

-
Image
  Choosing a medical billing services company can be a game changer for a healthcare brand in terms of how they handle charges and claims and how quickly they can move from charges to reimbursements. However, there are so many third-party service providers in the market. How does one make the right choice? Here are some of the key factors to consider when it comes to picking a billing service provider for your needs. Experience One of the first things to consider while hiring a medical billing services company is their experience. The number of years they have been in service will tell you their ability to sustain in an extremely competitive field and make things work. Quality of workforce Just like how you see the number of years of existence of a medical billing services company also check the average work experience of their staff. If the average number of work experience of their staff is 2 years, it means they have a lot of new hires. However, if the average work experie
Post a Comment

How important is denial recovery services for a healthcare practice?

-

 

Denial management service is something that’s becoming a norm with more healthcare practices. You either have an in-house denial management team or hire an expert from outside. Denial recovery services, which is the same yet different than denial management services, is a new concept that’s gaining popularity in the healthcare RCM industry.

 

What is denial recovery service, and how is it different from denial management?

 

Denial management is the comprehensive process of identifying the root causes of denials, taking organization-wide strategies to address these problems, and trying ways to reduce the rate of denials.

 

Denials recovery service is a part of denials management and is laser-focused on saving denied claims. As the name specifies, this is aimed at recovering claims that would otherwise have to be written off.

 

Some denials are hard denials, which means there is nothing you can do about them. Soft denials, however, have room for recovery, and denials recovery experts hold on to this smallest space and try to win back the claim.

 

If denials management is the police department, denials recovery could be a specific task force team that is focused on a specific issue.

 

Why is denial recovery service important for healthcare?

 

The payer denials rate ranges between 2% and 49% in the United States. The average rate of denials falls somewhere around 11-15%.

 

Let’s say your denial rate is 15%, which means 15 out of every 100 claim you submit is denied. Your denial management team may be able to save 3% of these denied claims, bringing down your denials rate to 12%, which is still in the mid-range when you compare industry standards.

 

Let’s say a denial recovery service expert takes over your denials. These experts come with focused knowledge on what to do for each type of denial. They customize their working strategy based on the type of denial and work quickly and swiftly to send across a successful appeal.

 

With smart denial recovery services, you may be able to bring down your current denial rate by 6%, which brings the number to 9%, which is lower than industry standards. For a healthcare organization that bills hundreds of thousands of dollars each month, saving 6% of their denied claims can result in a significant increase in the cash flow and revenue.

 

Why can’t you redo all soft denials internally instead?

 

This is a question that some practices may have. Why can’t the internal billing team appeal all soft denials instead of paying a denial recovery service expert to do the same?

 

This isn’t that simple. Appealing a denied claim costs the practice around $118, according to a report. Let’s say a hospital sends in 1000 claims a month. 15% of the claims were denied, and that means 150 claims were denied.

 

You spend about $118 to appeal each denied claim and end up spending $17,700 each month on appeals. If not done strategically, none of these appeals may pass through. If by luck, a few get accepted, you will still not be able to break even and will be losing thousands of dollars a month.

 

A denial recovery service expert knows which appeals have the higher chance of succeeding when re-sent and has a clear process of what’s to be done to send them strong. That increases the chances of denials getting reversed.

 

Takeaways

If you are a healthcare practice that struggles with a high rate of denials and a low rate of denial reversal post-appeal, then denial recovery services could be just what you are looking for. Make sure you pick the right expert and discuss their strategies in advance to hit your targets in the first go. 

Read more:

 The benefits denial management services bring to small healthcare practices

 BOT automation – The future of healthcare RCM

 How can effective RCM services positively impact behavioral health practices?

Comments

Post a Comment

Popular posts from this blog

Top 5 Challenges Affecting Revenue Cycle Management Services in 2023

-
Image
  Revenue Cycle Management (RCM) is an integral part of healthcare systems and helps keep bills paid, denials low, bills paid, and revenues flowing. While some practices opt to handle Revenue Cycle Management services  in-house, most of them take the help of third-party service providers to handle the most important part of their backend operations.    RCM strategies and processes keep getting updated over time. Every year, RCM experts need to learn, unlearn, and relearn what they know if they want their skills to be relevant. Here are five top challenges affecting Revenue Cycle Management services in 2023. Handling these challenges would help improve the services rendered and make a difference.   1.   The importance of prior authorization and verification   The insurance payers are going to require more services, and patients have prior authorization before they receive a service. With the need to quickly get appointments and treatments offered to patients to improve patient experien
Read more

Why should you only work with RCM service providers who can take over complete account management?

-
Image
  A lot of healthcare practices choose to work with third-party RCM service providers, and there are a lot of reasons for this. If you have been thinking of hiring such service providers or want to change your current service provider, then one thing you need to ask them is whether they handle complete account management.   What's account management, and why is this important? Keep reading to know all about account management RCM services and their benefits.    A third-party service provider can definitely give you more value for the money you spend in hiring them because: 1.   They come with exclusive expertise in the medical billing and coding industry 2.   You don't have to worry about handling staffing issues 3.   You get to use high-end tools and software that these service providers have spent time and money building 4.   You get to focus on your expertise - treating patients   However, many clients choose a third-party RCM service provider with only cost in mind, and end
Read more

Understanding Eligibility and Benefits Verification And Their Importance

-
Image
  Eligibility and Benefits verification is one of the most needed steps for effective RCM. Missing this is like constructing a building with a weak foundation. You cannot expect the building to thrive. Eligibility and Benefits verification  is the process of verifying information like coverage, deductibles, copayments, and co-insurance before filing a claim.   A 2020 report released by the Centers for Medicare and Medicaid Services (CMS) states that claim denial rates ranged between 1% and 80% in the country! An average of 18% of in-network claims got denied that year. This could be a considerable number, given the high cost of healthcare.   Claims need to be built based on the eligibility of the patient. A haphazardly created claim with services the patient was not eligible for in the first place would lead to quick and hard denials from the payer's (insurance provider's) end.    Inefficient Eligibility and Benefits verification  processes cause the following problems.   ·  Hi
Read more