Denial Management Services – Fidelity Health Care Solutions

FHS Denial Management

Medical claims Denial is one of the biggest problems faced by doctors, physicians and other healthcare professionals. Although the usual best practice recommendation is to keep the denial rate at 4% or below, a typical American hospital can easily experience an initial rejection rate of 7-10% for its claims. For many organizations, such denial rates often result in operational losses, and these losses will never be recovered.

FHS denial management service is designed to screen your data to discover the root cause of all denials. Our team can analyze, track, and report denials, identify unpublished rules, and provide suggested remediation methods for individual denied claims. At the same time, we can help you identify and implement process improvement measures to eliminate recurring denials and optimize revenue.

Our Strategies To Minimize Denials

Every company needs to take some steps to improve the medical billing process and reduce the number of claim denials. At FHS, we use the following strategies to reduce the number of rejections

Patient's Eligibility

Our professionals are trained to collect information about each patient’s health insurance coverage and benefit eligibility. Our practice management system can even verify the eligibility and benefits of patients before they are admitted to the hospital.

Prior Authorization

We follow a process to ensure that your scheduler is pre-authorized for every service that requires it. We will investigate the pre-authorization requirements for in-office services that are usually ordered during patient visits so that your employees know when to obtain the authorization before providing the services.

Claim Submissions

With the transition to ICD-10, the increase in coding errors may lead to more claim denials. We will take proactive measures to reduce coding errors, determine the services that your practice usually provides, and then seek expert advice on how to code these services. FHS has coding experts who will review and verify the code before submitting each claim.

Medical Necessity

The insurance company may refuse the claim because the diagnostic code given does not support the demand for the service provided. To avoid this, we use software with editable fees to determine the coverage. We will also collect policies on medical necessities from all your insurance companies.

Services We Offer

Considering the forecast that the entire industry will reduce revenue in the next few years, medical institutions must understand, quantify and resolve the root causes of current denial of claims, and establish a reliable denial management process.

Determining The Denials Reasons

The first step in our process is to determine the key reason for the denial of the claim. When the adjudicated claim is returned, the payer will return the status code and the reason for the remittance.
To understand the common and hidden reasons for constant denial, a thorough review of your billing procedures and management may be required. Our team at FHS know exactly where we should look for and solve problems in order to reduce denial reductions and exercise effective claims management.

Categorize The Claims Denials

After determining the number and reasons for rejections, our next step is to classify the rejections so that they can be monitored and routed to the appropriate department for remediation. Categorizing and analyzing rejections by category will help identify opportunities to modify processes, adjust workflows or re-educate employees, physicians and clinicians.

Prevention And Monitoring

Denial management is an ongoing process that must be continuously monitored and evaluated to prevent repetitive revenue leakage. Our professional team at FHS can help

Create a multidisciplinary team that can analyze rejection information and review trends as a team, determine the categories to be addressed first, and discuss their solutions.
Schedule regular meetings with multidisciplinary teams to focus on specific denial categories
Continuously monitor the effectiveness of these internal control measures in managing and preventing rejections to ensure their effectiveness.

Implementing Tracking Mechanism

After categorizing the reasons for claim denials, we develop a reporting mechanism through which the following information can be easily determined

Top denials categories that affect the organization.
Affect the organization’s revenue in terms of the amount of the claims denied.
Top department/service area affected by the denial of claim.

Why Choose FHS Denial management services

What Can We Offer You?

Understanding the various reasons for denials can improve long-term efficiency and greatly reduce loss of income. FHS denial management process in the medical billing application can help you effectively analyze the remittance proposal, thereby revealing the opportunity to effectively prevent rejection.