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    Improve your claim denial management

     

    3rd: Bring it together

    Attacking denied claims in advance, before they happen, is the objective. This allows providers the opportunity to chip away at that 90 percent. While there are many ways to affect this number, here are three important tactics to start with:

    Patient eligibility should be high on the provider checklist. Checking patient eligibility in advance ensures that patients have insurance to cover the treatment. 

    The claim itself must be clean: treatment codes, which change over time, must be kept up-to-date. 

    No matter how much effort is expended verifying eligibility and checking claims, some will be denied. But even this event has a positive outcome: Practices can understand and identify the common reasons for denials, which will help prevent them in the future. 

    Automating this portion of the revenue cycle management process can provide exceptional value to providers as the process also influences the more than 50 percent of denied claims that are never resubmitted to payers. The best solutions examine current and retroactive denials to ensure the practice receives all the reimbursement it deserves, which helps ensures providers get on the right side of that 90 percent. 

    Kevin Lathrop
    Kevin Lathrop is president of TriZetto Providers Solutions, which provides revenue cycle management systems to providers.

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    • [email protected]
      Great article , completely agree Physicians need to focus on what they trained for and outsource the rest to people who are experts in that field #prime healthtek

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