Denial Management In Behavioral Health Billing
An integral facet of behavioral health billing and revenue cycle management, denial management assumes paramount significance. Patients predominantly utilize health insurance plans for healthcare payments, necessitating meticulous billing and claim submission by medical practices. Upon the insurance company's coverage of medical service costs and the patient's fulfillment of any required copays or coinsurance, the healthcare practice transitions to the next patient, initiating the cycle anew.
In an era where healthcare complexities burgeon, and insurance plans extend their coverage, the guidelines and regulations set forth by these entities can overwhelm less-equipped providers with denied claims. A multitude of unresolved denied claims can deplete revenue for behavioral healthcare providers, impacting various facets of their practice, including staff, physicians, equipment, and patient care.
Recent appraisals highlight that the expense for providers per claim resubmission may exceed $100, exclusive of the initial costs incurred during claim submission, probable additional denials subsequent to revision, and the consequent repercussions on cash flow. Significantly, research discloses that a substantial 65% of denied claims are left unattended, although it is established that two-thirds of these claims can be recuperated. Considering the costs associated with denials and subsequent follow-ups, medical practices confront a swift depletion of revenue
Identifying Claim Denial Reasons
As a trailblazer in revenue cycle management and behavioral health billing, Reveloop continually scrutinizes experiences to progress and enhance solutions, staying abreast of the most effective approaches. Claim denials can arise from clinical factors, including the denial of a procedure on grounds of medical necessity or it being conducted by an out-of-network physician. Administrative issues, ranging from coding errors to incorrectly submitted claims, also contribute to common denial instances. Other prevalent causes of denials include
Addressing Root Causes
Behavioral healthcare providers grapple with various challenges, notably
Our Denial Management Services Include
Audit Management
Our audit management services provide a pragmatic avenue to regulate behavioral healthcare expenses. This encompasses validating diagnosis-related groups (DRG), handling clinical appeals, conducting retrospective audits, and aiding in under-billed audits.
Effective Denial Management
Central to our paradigm of revenue cycle management is an emphasis on adeptly handling denials to exercise control over costs. Our aim is to reduce the number of denied claims while improving overarching strategies. Crafted for convenience and requiring minimal oversight from your behavioral healthcare staff, our process ensures a seamless operation.
Expertise and Technology
Harnessing years of experience and diverse backgrounds in healthcare and medical billing, coupled with one of the most cutting-edge EHR systems, Reveloop facilitates addressing pain points such as common denial reasons and streamlining internal workflows. Real-time access to denial status and interaction with our seasoned team for queries or suggestions are inherent benefits.
Managing Appeals Process
Should an appeal become imperative post-resubmission, we adeptly manage the process until its ultimate adjudication. Continuously seeking opportunities to enhance our approach, our team in denial management collaborates and strategizes for improved methodologies, should more effective strategies arise for addressing denials or enhancing claim submissions.
Reveloop's Denial Management Process
Benefits of Denial Management
More Clean Claims
At the core of our denial management process is the identification of root causes and the implementation of preventive measures. This enhances your clean claims rate and alleviates both administrative burdens and costs.
Boosted Net Revenue
At the core of our denial management process is the identification of root causes and the implementation of preventive measures. This enhances your clean claims rate and alleviates both administrative burdens and costs.
Better Patient Care & Loyalty
Effective management of denials guarantees a more seamless billing process, averting disruptions that could cause frustration for patients. The reduction of payment delays contributes to a positive patient experience, nurturing satisfaction and loyalty.
Improved Operations & Lower Costs
Reveloop's denial management services enhance operations by streamlining the processes involved in submitting claims and reducing rework costs. By concentrating on preventing denials and giving priority to clean claims, we preserve valuable staff time and resources for your practice.
Direct Lines To Growth
Reveloop's committed team stays updated on the most recent coding guidelines, payer prerequisites, and strategies to prevent claim denials. This dedication ensures that your practice maintains compliance and efficiency in handling claim denials, creating direct avenues for growth.
