Denial Management

Denial Management (Identification, Appeals, & Resolution) Every medical practice experiences claim denials.  Better performing practices have denial rates below 5%, other practices are seeing claims being denied at 10%, 20% or in the extreme 30%.  We evaluate the practice denials by identifying why claims are being denied and how many claims, categorize the denials and take action.  With that information we can determine what your practice needs to do different to reduce the denials and increase the percentage of time that you get paid.

Address all denials within 7 days

The healthcare environment is changing.  The Affordable Care Act and the transition to ICD-10 put an added layer of expense and complexity on our already burdened system.  Patient volumes are on the rise with the newly insured, and high-deductible plans are putting added pressure on revenue cycle operations and their drive to collect.

The key to success is access to a large pool of qualified denial management resources that work in any Practice Management System and understand how to quickly and correctly analyze account history, appeal denied claims, and get timely turnaround to recover on and close out A/R.  Analysts adept at trending denials and looking for patterns of deficiency will increase cash flow and reduce aging A/R.

Smart MBBS provides the access to a large and scalable pool of resources experienced in multiple Practice Management Systems.

Maximum reimbursement:  Claims are followed up systematically and quickly. Claim follow-up is handled utilizing our electronic clearinghouse, insurance websites and direct contact via telephone. We diligently pursue your claims for maximum reimbursement and appeal your denials.

Aggressive Follow-up: All unpaid claims are aggressively pursued by the AR team daily. We will keep calling and asking for explanations and ways to fix issues, until every cent due is paid. We are experts at getting through to the insurance companies to dispute improper denials and slow payments.

Claim appeals: Denials and rejections are always handled by an appeal. Once the denial is evaluated, we utilize our appeal process to handle incorrect claim denials. Claims are never written off without being appealed first.

Don’t leave money on the table: Up to 70% of your denied claims can be recovered. The Smart MBBS A/R team can see your denied claims are recovered. We are known for high performance in the following:

Clearinghouse Rejections

Rejections are resolved within 48 hours

No-Response Follow-Up

Perform status checks on higher dollar balances and identify issues proactively to reduce aging and maintain an untouched ratio of under 3% of the overall inventory

 Credit Balance – The credit balance is a liability that is hidden within the accounts receivable ledger. This liability carries with it real and serious financial and compliance risk. It is your fiduciary responsibility to manage these real risks.  Industry data shows that over 55% of credit balances are a result of incorrect posting of allowances.

Smart MBBS has built strong working relationships with our clients to consistently meet their needs as credit balance backlogs are prioritized and processed. Incorrect adjustments, erroneous credits, and misuse of debit codes makes this credit balance task quite challenging, requiring precision, attention to detail, and a focus on operational excellence.

Smart MBBS has maintained a team specialized in credit balances resolution since 2010. The team is comprised of highly-qualified individuals with a hospital accounting background and strong analytical skills. All Smart MBBS analysts are diligent and well trained to ensure outstanding credit balances are accurately resolved in an expeditious manner. We understand a professional and cooperative environment is the key to resolving more credit balances, many of which become ‘account corrections’ as opposed to actual ‘refunds’; hence, our operational model is highly client-centric.

Highlights of our capabilities:

Analyze accounts along with EOBs

Work all assigned accounts – big and small-balances

Resolve all accounts – inspect for patient liability or other adjustment issues

Determine if double payments were made – if so, refund as required:

By patient and insurance carrier

By two insurance carriers (both acting as Primary)

Check for duplicate payments made for the same account

Smart MBBS provides the highest levels of security, with internal control audits and HIPAA compliance.

By taking charge of your credit balances, Smart MBBS can expeditiously decipher, process and post refunds and/or account corrections to consistently ensure the overall integrity of your revenue cycle.