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In the era of digital innovation, we can’t ignore the significance of denial management. An effective denial management program is necessary to identify the root causes of denials and finding solutions to prevent this issue in the future.

As the healthcare industry moves toward cost-based payment and in order to avoid heavy loss-making the shift from denial management to denial prevention is essential because healthcare organizations are losing billions of dollars to denied claims.

Moreover, it is estimated that 65% of denied claims are never been resubmitted and over 80% of claims are denied for a reason that can be prevented. 

Healthcare organizations are now getting the importance of a proactive approach that prevents initial denials at the beginning of the revenue cycle

As, it has been said, “Prevention is better than cure”. This saying can also apply to claim denials 

Prevention means removing the issue so it never happens again. 

While managing will continuously be a part of the process. However, managing denials will require a lot of time, money and resources.

In this infographic, we provide you the top reasons for denials that you can take to prevent denials. 

Here are some steps of denial prevention!

Effective Denial Management Framework

To avoid denials you must understand the magnitude of the problem. Effective denial management is necessary to achieve a 100% clean submission rate and increase your practice revenue while improving patient satisfaction. 

However, to make a framework for an effective process you should consider the problem at hand 

Denial Rate, % of high dollar value claims that have been denied as a % of the total number of denied claims, % of claims appealed. These three measures will help you to understand the problem. 

Identify The Root Cause 

Finding and understanding root causes is the key to prevention. You have to understand the root cause of each denied claim that will help you to see where the issues arise.

Measuring The Success of Denial Management Program

It is difficult to measure the overall reduction and success in denials or claim appeals. However, short term goals will help you to measure the denial success and find a significant change in the denial rate. 

With a strong denial management program, you can achieve a sustainable increase in revenue and shift your focus towards preventing failure.We at med-miles LLC resolve your claim denials and rejection issues. We will take charge of your medical claims, including appropriate billing and coding, tracking to maximize your revenue through our effective denial management service.