Denial Management TIPS on How to Improve the Process

A denied medical claim can be stressful and disappointing for medical billers and physician practices as well. A denial of any medical bill can happen due to the following reasons:

  1. Error while typing due to carelessness
  2. No or less working experience in related field

iii. Misinterpreting the information

  1. Coding in an inappropriate manner
  2. Insufficient or missing information given by the provider to the biller
  3. Due to other technical issues

Resubmission of the claim is possible after fixing the issues in an appropriate and systematic manner. However, claim resubmission is an additional process and extra work that your medical billing resources have to perform along with the submission of the recent claims. Medical Group Management Association (MGMA) states that it requires up to $25 copping up with managing the denied claim. However, the improved process of denial management is preferable. In this way, one can maintain a good repute in the respective field and can gain the trust of the payers more efficiently. It appears discouraging to manage a denied claim. It requires much expense and consumes a lot of time to identify the mistakes pointed out by a certain payer due to which the claim was denied. For sifting through this problem, a denial management system can be useful and helpful for physician practices.

Web-based denial management system:

It should be the main aim or target of every physician practices and medical biller to get the claim approved in the first time. With the modernization of technology, there are numerous authentic online denial management software systems to provide you with the optimum results and with the higher probability to approve your medical billing claim in the 1stpass.

Outsourced denial management:

Implementation of an outsourced denial management can cut the labor cost as well as the increasing burden on your in-house staff. By using such approach, you can get paid more, in place of working harder for less amount of money.

In depth analysis:

For implementing the most suitable denial management system, deep observation and in-depth analysis of your revenue as well as of ratio of denial should be done. Physician practices can go for one of the following options:

  1. To have a solitary denial management system and attach it to their practice management system.
  2. To go for a denial management system that is entirely in combination with practice management system (recommended the most).

An effective and desired Denial Management System Should be Inclusive of the following features:

Real-time Analysis of claims:

Analyzing claims at the actual time of occurrence of relevant procedures safely guards the integrity of the information.

Rules upgrader for tracking denial activity:

Upgradation of the rules regarding denial managing system is highly desirable for tracking the denial by the payers. This can be achieved with the help of professional denial management team, dedicated and skilled to handle the payment denials.


The denial management system should be flexible enough to be combining withother software systems to assure quick and easy upgradation in ways of rule-making and coding.

Systematic responsiveness:

For improving the transparency of payment and making sure that you aren’t going to get paid less due to the underlying possibility of a denied claim, there must be systematic responsiveness regarding the status of claims and of their resubmissions.

Customization option:

The data you’ve entered, while medical billing in real time should be able to be customized for assurance of the accuracy of paid claims and to find out the areas where improvement is required. An effective management of the denied claims can reduce the losses and physicians practices can easily identify the problem area.