Denial Management Archives - InfoHub https://infohubservices.com/blog/tag/denial-management/ Tue, 15 Nov 2022 09:08:14 +0000 en-US hourly 1 https://wordpress.org/?v=6.1.1 https://infohubservices.com/wp-content/uploads/2019/10/cropped-INFO-HUB--32x32.png Denial Management Archives - InfoHub https://infohubservices.com/blog/tag/denial-management/ 32 32 A Guide for Comprehensive ” DENIAL MANAGEMENT” https://infohubservices.com/blog/a-guide-for-comprehensive-denial-management/ Tue, 15 Nov 2022 09:00:40 +0000 https://infohubservices.com/?p=47442 Denial Management, in simple words, is a strategic process that resolves any issues which might cause claim denials. Both rejected claims and denied claims have the potential to be a huge issue for healthcare organizations. Denial management is considered one of the most complicated yet vital parts of the revenue cycle management process. Seeking professional help from a medical billing company with the right tools is considered the most convenient solution here.
As denied and rejected claims have a direct impact on the revenue cycle, it is important to get it right. It is advisable to employ a system monitoring the denials and what causes them. This is one of the most important steps to take into consideration before you try and look for solutions. So here is a comprehensive guide for the Denial management process.


There are two types of Denials

  1. Hard Denial – A hard denial is permanent, and cannot be corrected or reversed. Hence the revenue over which is considered to be lost.
  2. Soft Denial – A soft denial is temporary, and is payable if the necessary information is added or rectified.


Claim Denial can be a result of many issues.

Here are the top five to keep an eye out for:

  1. Duplicate Claims – This situation arises when a claim is submitted for a single encounter on the same day for the same patient by the same provider for the same service team.
  2. Incorrect or Missing Information – This covers anything from a missing field or blank field to coding errors.
  3. Prior Authorization – Before service is performed if prior authorization is not being taken then the claim can be denied.
  4. Benefit Coordination – Patients who are covered by more than one health plan can lead to delays or denials of claims. This can be avoided if the patient’s benefits are coordinated.
  5. Network Provider – If the services are provided by an out-of-network provider can lead to the payer denying to pay the claim or a part of it.
  6. Deadline Exceeded – When the payer’s required days of service are exceeded it can lead to delays in claims.

Once you have correctly located the causes for denials, here comes a tougher task. Denial management and making sure that it does not occur frequently is a meticulous procedure.

Here are a few things to keep in mind to make this process easier:

  1. Common Reasons – Denials or delays in claims can occur due to various reasons. It primarily depends on the type of healthcare organization and the scale on which they function. If there are any repetitive errors occurring then specific changes along those lines need to be made.
  2. Quick Assessment and Action – In case any denials take place or if there are any delays then it is important to follow up and get them corrected. The preferred time limit for this is within a week.
  3. Clear Delegation of Jobs – Managing the denials procedure is a tedious process. It consists of a lot of steps and they need to be error-free for a seamless workflow. If the work is delegated amongst different departments or outsourced to medical billing agency or a medical billing company can assure error-free and hassle-free work.
  4. Establish A Work Model – In any healthcare organization denials are an integral part of the revenue cycle. An effective work model in place can help you handle this issue in a much better manner.

Keep The Process Organized – An organized denial management process can facilitate solutions to resolve any delays or denials in claims. Denied or delayed claims can lead to a reduction in revenue and some grave administrative issues.


Financial stability is vital for any healthcare organization. A sustainable Denial Management process can help streamline the process while weeding out any causes leading to denial or delays. A simple solution could be to outsource medical billing services to a medical billing agency.


We, at Info Hub, provide the best-in-market medical billing services equipped with an experienced and skilled team to turn denials into revenue.

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A Guide on Optometry Billing https://infohubservices.com/blog/a-guide-on-optometry-billing/ Mon, 27 Jun 2022 13:26:11 +0000 https://infohubservices.com/?p=46368 Optometry has highly precise documentation and reporting protocols, norms, and regulations to follow, much like any other specialty. All practises must go by these regulations, which are stringent in terms of timelines and accuracy, and insurance companies will call them out if they don’t adhere.

All claims must be extremely thorough and error-free in order to be properly paid by any insurance company. Thorough, prompt, and documentation of all interactions is essential for a healthy connection between the physician, the patient, and the insurance company.

Trained employees and equipment are necessary for an optometric practise to maintain a steady cash flow. The submission of accurate claims is essential to the operation and must never be left in the hands of an untrained employee. It’s critical that you and your employees have proper training in optometry coding procedure if you want your office to run smoothly. Knowing how to perform billing and coding for optometry is the key.

Optometry has 16 different ways to code eye exams, thus it’s critical to comprehend the meanings and applications of these fundamental codes. The 16 mandatory codes are divided into three groups: 2 HCPCS “S” codes (S062X), 4 ophthalmic visit codes, and 10 assessment and management (E/M) numbers (992XX) (920XX). There are three common coding sets used in optometry. They include:

• The majority of procedures use CPT codes.
• The Health Care Procedural System for all non-CPT covered operations
• The ICD-10 diagnosis codes

Using the Appropriate CPT Code Modifiers

Given that services are frequently complicated, CPT code modifiers aid in adequately describing them.

You can accomplish the following with its assistance:

• Determining the necessity of the procedure.
• Being aware of the number of doctors treating the patient.
• If there have been a lot of previous procedures.
• Where the operations were performed, among other details crucial to a claim’s position with the insurance funder.

A substantial percentage of medical claims are rejected if it’s used incorrectly. RT/LT for the left and right eye/lids make up the most common modifier for ocular inspection. Additionally, the E1-E4 modifiers aid in distinguishing between the superior and inferior lids as well as the left and right lids. As a result, they are typically combined with a hyphen and put to the end of a CPT code. Before using any of the CPT code modifiers, it’s important to understand their varied applications.

Here are some tips for optometry medical billing to ensure that your practice does not lose out on revenue and gets appropriately reimbursed.

Verify Patient & Insurance Provider Details

Ensuring the provider has been given the insurance payer’s approval (credentials) is one of the initial steps in optometric medical billing.

As per the rules of the insurance plan, don’t forget to file and monitor provider credentialing applications. Whenever enrolment is open, go one step further and routinely check in with insurance payers to ensure that the providers are included in the network.

Maintain Accurate E&M Records

Maintain thorough records that details Evaluation and Management (E/M) service. To assist clinicians in streamlining patient record documentation, CMS announced a number of modifications to E/M documentation beginning in 2019. For E/M office/outpatient visits, doctors are no longer required to re-enter or re-document the patient’s principal complaint and any history that auxiliary personnel or the beneficiary had already recorded in the medical record (both new and old patients).

Collect Co-Pays and Deductibles Upfront

Creating an upfront collection plan is one of the quickest methods to improve your practice’s cash flow. If the patient’s insurance plan has a co-pay, coinsurance, or deductible, always collect it before they leave the clinic during check-in or check-out. Sending invoices ahead of time improves your chances of receiving payment on schedule and decreases Accounts Receivable (AR) delays. Additionally, open balances give a deceptive impression of your AR.

Follow-Up With Denied Claims

Finding the reasons why the claim was initially rejected is never at the top of the list of preferred tasks. The good news is that approximately 90% of denials can be prevented, and on average, two-thirds of them can be recovered. Even while it takes time and frustration to figure out why the insurance payer initially rejected the claim, the longer you wait to figure out what went wrong, the less likely it is that you will be able to collect the whole amount (or any amount) from the insurance provider.

Below is a list of common optometric billing and coding errors

Every optometrist should be aware of and steer clear of these three typical optometry billing and coding mistakes. These typical errors include:

Over-Coding

When you charge for a level of service over what is reasonable, you are over-coding an examination. When an E/M level 4 substitutes the medical record that supported an E/M level 3, for instance.

Under-Coding

It is the most typical mistake in optometry. At a lower level than the examination, judgement assistance, and patient history, it entails charging a problem-focused evaluation and management office.

Payable Processes

This mistake is similar to the under-coding mistake, except it goes a little bit further. It occurs when the patient’s medical insurance is not billed for the examination after the coding process is complete.

Info Hub, an offshore medical billing and coding company specializes in Optometry billing, and has a vast experience in offering its services to physicians and hospitals. Our expert team is well trained in ensuring error-free claims, and help increase practice revenue by reducing claim denials, meticulously following up on denials and more.

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5 Reasons You Need an Offshore Medical Billing Company https://infohubservices.com/blog/5-reasons-you-need-an-offshore-medical-billing-company/ Thu, 23 Jun 2022 06:50:52 +0000 https://infohubservices.com/?p=46332 Medical billing entails back-end responsibilities such as addressing medical billing errors and increasing cash flow that cost time, effort, and resources, diverting attention away from patient care and concern. Discrepancies in billing can result in lost revenue, more effort for your hospital personnel, and a poor patient experience, all of which can harm your medical practice’s reputation in the long run. It’s not surprising, however, that many medical practises in the United States have chosen to outsource all of their medical billing and coding to offshore medical billing companies who specialise in this service.

Is your practice witnessing a downward trend in its finances? Is your stress affecting your patients? Using the expertise of an offshore medical billing company has a number of benefits. Read on to understand the most significant ones that can prove rewarding to your practice.

Cost Effective

Working with an offshore medical billing business takes care of the full administrative process of billing, coding, and collection, allowing you to spend less time on front-end staff hiring and training, as well as maintaining an IT infrastructure. You also have access to the agency’s existing pool of qualified medical billing professionals, making it simpler to expand backend operations at a lesser cost. Apart from facing potential losses due to errors, the expense of constructing infrastructure, resources, and training staff can increase the medical organisations’ expenditure.

When you outsource your medical billing, the entire administrative cycle is handled for you, and your overall cost is reduced to almost half on an average.

Increased Revenue

To prevent insurance denials, all claims are submitted electronically, which lowers time-to-collection. Claim forms are carefully examined by a qualified team before submission. Partnering with an offshore medical billing company frees your staff, thereby allowing them to focus on explaining to patients and their families the estimated cost of health care procedures, their out-of-pocket expenses, and the payment choices accessible to them, instead of making follow-up calls to insurance companies or entering data. As a result of all of this, payment collection will improve.

Compliance

Concerned about laws and regulations? When you work with offshore medical billing service providers, they handle all of the legal aspects of the transaction for you. If the terms HIPAA and Hitech make you nervous, rest assured that they’ve previously been addressed. The majority of offshore companies are compliant and qualified to handle sensitive data.

Better Control of Billing Process

Many medical practises are hesitant to deal with an offshore medical billing company because they are concerned about losing control, but this is not the case. Because medical billing is such a competitive field, your offshore medical billing company will go to great lengths to keep you happy. Only by reducing your collection time, minimising billing errors and claim rejections, guaranteeing that prices do not spike as you grow, and giving frequent reports, will they be able to accomplish this. In other words, you have more control over your medical practice’s billing process.

Patient Satisfaction

While you focus on the most important aspect of patient care, the offshore team takes care of the rest of the billing needs. Your team will be better informed to answer patient payment queries, thanks to the systematic gathering of patient data and digital filing of claims. This leaves them with more time to communicate with patients and family members, quelling any anxieties they may have. Higher claim acceptance rates are achieved through digital claims filing and verification of claims by a team of billing experts on the back end.

Patient experience with a medical practise can be improved by being able to offer an instant approximation of medical expenditures, boosting the level of human engagement, and processing claims quickly.

However, attaining this may not always be simple. To begin with, medical centers must implement an effective EMR and billing software, as well as train their personnel on how to operate the billing systems. Staying up to date on developments in healthcare billing codes and laws is often a challenge.

Info Hub, an offshore medical billing company caters to physicians and hospitals across a variety of specialties. The team at Info Hub has well-trained professionals who are updated with latest changes in the healthcare. With its extensive experience and expertise, we can help improve your revenue collection, reduce overhead costs and enhance patient satisfaction. Our customized solutions to every practice that leads to a streamlined medical billing process that is crucial to the financial health of a practice.

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Do’s & Don’ts of Medical Billing https://infohubservices.com/blog/dos-donts-of-medical-billing/ Mon, 13 Jun 2022 11:24:29 +0000 https://infohubservices.com/?p=46307 Medical billing entails a long process of activities, each stage significant to ensure full reimbursement. Majority of the physicians and practices suffer lower revenue collections owing to certain incorrect medical billing practices. Incorrect coding, piled A/R, lack of follow-up can all affect your practice’s financial health. We understand how important it is to strike a balance between offering patient care and steering clear of billing and coding errors that sometimes plague practices.

In order to stay financially strong and healthy, practices must follow a few dos and don’ts of medical billing. Read on to know more –

Don’t Ignore Denials

Setting up a process of balances will maximize first-pass rates, irrespective of whether a practise uses a medical billing agency or processes claims internally.

When denial rates are higher than predicted, it may be a sign that your team needs advanced training or that the scrubbing procedure is inadequate for your existing workflow.

The following are some of the most common causes for denials:

• You don’t have enough supporting paperwork

• Your doctors aren’t properly certified

• Codes are used for services and equipment that are not covered by the carrier

When you keep track of denial codes, you could see some simple ways to improve your practice’s efficiency.

Don’t Forget Check-In Policy

When a clear policy is in place and followed every time a patient checks in, the chances of medical billing complications are reduced. Before you do anything else, make sure your patient is aware of your payment procedures, and that all of their data is correct and complete. Even if they are regular patients, it is a good idea to have them double-check and confirm that their information each time they visit your clinic.

Don’t Fret Over Appeals and Claim Denials

Despite a near-perfect medical billing process, claim denials still happen. The best way to deal with claim denials and appeals is to employ medical billing services that can devote the necessary time to resolving the problem and obtaining approval for the claim. You must deal with appeals in time to avoid any losses.

Do Maintain Updated Patient Files

Handling claims with accuracy is difficult if you don’t have the correct information on all of your patients? At each visit, you’ll need to remind employees to double-check patient demographics and insurance information. A patient may have a policy change for a variety of reasons.

Explaining the procedure as you update their information will help so that they aren’t taken by surprise with unexpected charges. Double-check data, like the insurance details and information, including the health insurance company’s billing address. It’s critical that this information verifies the records of third-party payers.

Do Have a Medical Billing Assessment

The regulations and environment of medical billing are continually evolving. Billing assessments guarantee that your practice’s billing processes and technology are up to date and suitable. Assessing your present billing system will help you find areas that want improvement and provide you with the direction you need to make it more productive and cost-effective.

Do A Double Check on the Billing

Having a process in place to detect claim problems before they are submitted is the simplest method to be compliant and prevent claim errors. Although human error is unavoidable, utilising technology – claims scrubbing, rules engines, etc. can significantly reduce the likelihood of denials.

It’s critical to train your team and provide them with the resources they need to conduct accurate claims processing for the health of your practise’s bottom line. The finest thing you can do for your company is to have all of your accounts managed by professionals. Medical billing and coding is a complicated process that should only be handled by experts. Info Hub, an offshore medical billing company offers impeccable services in billing, coding, credentialing, A/R follow-up and more, and to all specialties. Our dedicated team for every service ensures you get reimbursed correctly and on time. Medical billing services will help save you time and revenue in the long run, as well as relieve you of the burden of this task.

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Offshore Medical Billing – All You Want to Know! https://infohubservices.com/blog/offshore-medical-billing-all-you-want-to-know/ Thu, 26 May 2022 13:19:42 +0000 https://infohubservices.com/?p=45961 Medical billing involves back-end responsibilities such as creating patient bills, submitting claims, resolving billing errors or optimizing cash flow, interacting with insurance companies, which cost time, effort, and resources, diverting attention away from patient care and concern.

Are consistent billing errors or late reimbursements plaguing your practice? Offshore medical billing is the solution for when you are looking for efficiency in the financial health of your business and ensuring complete focus on patient care.

Here is all you need to know about offshore medical billing, and how it can be an effective solution to the challenges you face in your medical billing process. Offshore revenue cycle management includes –

• Setup of Practice Management System/EMR System
• Scheduling, Eligibility Verification, and Pre-Authorization
• Patient Registration
• Medical Coding
• Customer/Patient Access Solutions
• Accounts Receivable (A/R) and Denial Management
• Credit Balance Resolution and Management

Offshore Medical Billing Process

Plenty providers and hospitals have taken resort to offshore medical billing services as it offers multiple advantages. A typical offshore medical billing company entails the following –

  1. Patient enrolment – All insurance information is recorded into the practice management system. Insurance validation and approval, which includes validating coverage and out-of-pocket payments, and if necessary, acquiring pre-authorization/pre-certification.
  2. Coding — All offshore medical billing companies have AAPC-certified coders that give the most relevant ICD, CPT, and HCPCS codes to the charge team, so that they can file charges in accordance with payment guidelines. Before submitting a claim, the codes and accompanying costs are meticulously reviewed for accuracy.
  3. Payment Posting – Payments are posted, and missing, and/or denials are identified so that corrective steps can be taken as soon as feasible in order to ensure full reimbursement.
  4. Accounts Receivable Management – AR analysts in an offshore medical billing company help you keep your accounts receivables in check, follow up with health insurers and payers, and take steps to collect payments that are past due.

Compliance with HIPAA

Providers don’t have to be concerned about information security when they offshore their medical billing. The offshore medical billing companies are familiar with all HIPAA standards and protocols, and take steps to safeguard the security of all medical information. Computers with firewalls and anti-virus programs are installed, along with monthly backup. The companies also take care of on-site shredding of hard copies of patient data, and are on top of the most recent regulatory developments and make necessary revisions to ensure compliance.

Operation Management

Dealing with the full medical billing procedure can be and exhausting and time-consuming. However, because the process is complex and challenging, it is critical to hire and train the appropriate personnel. When you take help of an offshore team, you gain access to a larger pool of trained individuals who can complete the assignment, saving time and resources on training and hiring. The candidates are found following a thorough assessment and qualifying evaluation phase, as well as an interview and reference checks. You acquire the finished output with less effort and in a significantly shorter time frame. We stay on top of the newest policy measures and make necessary adjustments to ensure compliance.

Quality Service

You can take advantage of offshore solutions with customizable turnaround times and no quality compromise. Additional benefits include: strict quality checks; daily, weekly, and monthly reports; no worry regarding time differences between offshore locations; and weekly meetings to learn about the progress and review data.

Patient Satisfaction

While you focus on the most important aspect of care, the offshore team takes care of the rest of the billing needs. Because of the time zone difference, the offshore company can accomplish end-of-day tasks before the day even begins! This frees up time for you to focus on your main job: patient care and happiness.

Offshore medical billing companies have been around for more than two decades and is a tried-and-true concept that has aided the expansion of several healthcare businesses in the United States. Due to the ideal time difference (about 9 -15 hours), a large English-speaking talent, stable Democratic governments, and ultimately the economic advantage that can be used, India is considered to be the best geographical option to offshore. Info Hub, a leading offshore medical billing company, is the appropriate partner to help you do more with your revenue cycle, whether you need component revenue cycle operations like medical billing, medical coding, or accounts receivable management, or you want to offshore the full chain of the process.

Offshore medical billing companies understand the need of cooperating with onshore revenue cycle teams, and working with physicians to minimize revenue leakage, enhance reimbursements, and improve processing quality. We recognize the impact of each step from credentialing and enrolment to billing and collections.

Info Hub, a well-established medical billing offshore company, provides services that give you access to the latest technology and qualified staff to assure your practice’s financial success. Individual and group practices, hospitals, clinics, and ambulatory surgery centers all benefit from our personalized medical billing services. From patient enrollment and verification to collections, our medical billing company has proven experience in all elements of revenue cycle management. We operate as an addition of your facility to assist you increase production and optimize reimbursements while lowering your overhead expenses by 30-40%.

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How to Create an Effective Denial Management Strategy https://infohubservices.com/blog/how-to-create-an-effective-denial-management-strategy/ Thu, 28 Apr 2022 11:21:45 +0000 https://infohubservices.com/?p=45701 Medical claims are an important aspect of your practice’s revenue. When claims are refused, it can be a significant source of financial loss. Denied claims not only increase days of the revenue cycle, disrupting cash flow, but they can also cost you money if not resolved quickly. The cost of processing each refused claim further adds to the strain. Are you experiencing high denials, and looking for a sound strategy to manage these denials? It is important you understand why your claims are being denied, based on which you can devise a strategy to reduce further denials and keep your practice from losing revenue.

Types of Denials

  • Soft Denials – A soft denial is only meant to be temporary. If the claim is amended and/or further information is added, it may be paid.
  • Hard Denials – It is irreversible. It is revenue that has been lost since it cannot be rectified or restored.

Reasons Why Claims Get Denied

Identifying the cause for the denial is the very first step in an effective denial management strategy. When evaluated claims are sent unpaid, the insurer will usually explain why on the accompanying payment explanation. It’s vital to remember that the majority of people are unaware of the insurance denial process. It is your front office staff’s responsibility to emphasise the need of precise documentation and insurance information.

  1. Service previously settled
  2. Service unqualified under a healthcare plan
  3. Missed deadline
  4. Incorrect/missing information
  5. Duplicate claims

The following pointers form the basis for an effective denial management strategy

  1. Identify – Find and fix the problems that lead to claims being denied by insurers.
  2. Manage – Categorize denials according to their reason, source, cause, and other distinctive characteristics.
  3. Monitor – Keep track of denials, audit employees’ efforts, and give the tools, technology, and resources needed to get the job done.
  4. Prevent – Work with patients, recommending physicians, and others to appeal and overturn unjustified denials.

Read on to know more about how to go about developing an effective denial management strategy.

Re-submit Claims in the Stipulated Period

Follow your rejection management guide, evaluate the insurer’s associated denial communication, and double-check your internal documents. If necessary, contact the patient. Remember that most insurers have time constraints on resubmitting claims; the last thing you want is to be denied reimbursement because of a late submission.

Examine the Denials

The easiest method to deal with claim denial is to prevent it from occurring in the first place. According to industry sources, the typical denial rate for practices is between 7 and 10%, whereas there should be no more than 4% and no more than 2%. Preventive denial assessment is a root cause analysis of all denials received with the goal of lowering the denial rate in the future. Here are a few things you may to want to analyze –

  1. What was the source of the denial? Was it a billing error, a coding issue, patient eligibility, the wrong payer was invoiced, or anything else?
  2. Is it possible that this denial might have been avoided? The solution to this question will astound you.
  3. What could have been done to prevent the denial? Review your eligibility verification procedure to see if it needs to be fine-tuned if it was an eligibility issue.
  4. Perform an 80:20 analysis of your denials to determine which issues are the most bothersome and how they might be rectified.
  5. Don’t try to change all of your processes at once; taking it one step at a time will yield better outcomes.

Watch For Trends and Patterns

Denials frequently share at least a few common characteristics. Regular analysis aids in determining these trends and identifying causes, allowing you to better plan to fend off income threats.

Organize the Process

The denial management procedure should begin as soon as a denial is discovered. This entails the steps below.

  1. Directly route denials to the affected individual’s work list. A coding error, for example, must be reported immediately to the coder.
  2. Sort the assignments on the denial work list by cause, time, and cash amount
  3. Remember to act quickly to avoid automatic re-billing and to strengthen your case.
  4. Create a denial management manual for your workers and create a uniform methodology for each major type of denial.

Denial management is a continuous effort for all healthcare facilities, and it takes up a lot of staff time. You can lower your denied claims by offshoring your denial management process to a revenue cycle management business. Info Hub provides custom-tailored systems and reporting tools for each client. To help you enhance your bottom line, we offer the full range of revenue cycle management services.

We work with you at Info Hub, an offshore medical billing firm, to reduce denials and underpayments, manage claims, improve patient eligibility verification and payment collections, and reduce compliance concerns and risk. Contact us to improve the efficiency of your daily revenue cycle and business processes.

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Medical Claim Denials and Rejections in Medical Billing https://infohubservices.com/blog/medical-claim-denials-and-rejections-in-medical-billing/ Tue, 26 Apr 2022 09:35:19 +0000 https://infohubservices.com/?p=45674 Filing healthcare claims is a complicated and an ever-changing process, as innovation and regulatory requirements can sometimes seem daunting. Mastering claims processing is an on-going skill, but understanding the basics is the first step to accomplishing this world. Knowing the distinction between rejected and denied claims is one of the keys! One of the most significant roadblocks to healthcare reimbursement is insurance claim denials and rejections. In the billing sector, the phrases “claim rejection” and “claim denial” are frequently interchanged.

This misperception can result in expensive mistakes and have substantial impact on your revenue cycle overall. For timely cash flow, proper knowledge and administration of accounts receivable and process are required.

What is Claims Rejections?

Claims rejections are those claims that are rejected by insurance companies because they do not fulfil particular data standards or basic formatting guidelines established by the Centers for Medicare and Medicaid Services.

The insurance companies are unable to process these rejected medical claims since they were never received and recorded into their systems. The claims cannot be processed if the payer has not received them. Once the inaccuracies have been addressed, the claim can be resubmitted. These mistakes can be as basic as a misplaced digit in the patient’s insurance ID number, and they are usually easy to fix.

What is A Denied Claim?

Medical claims that have been accepted and processed by the payer but have been categorised as unpayable are known as denied claims. These “unpayable” claims usually have an error or a lack of previous authorization that was discovered post the processing of the claim. Missing information, non-covered services per plan, and even procedures that are not medically essential, are some of the reasons for denials. Although it may appear that resubmitting the claim for a second review is simple, a denied claim cannot be resubmitted. It’s important to figure out the reason why the claim was initially denied.

Denied claims can usually be rectified, appealed, and returned to the payer for processing. To get to the root of the problem, however, this method can be time-consuming, costly, and resource-intensive. If a denied claim is refiled without an appeal or reconsideration request, it will almost certainly be taken as a duplicate claim and denied again. If this occurs, the claim will go underpaid, which can have a significant impact on a provider’s practice, especially if it is a reoccurring problem. When resubmitting denied claims, time is also a consideration. Each payer gives you a specific duration to submit a corrected claim. If the deadline is not reached, the payer may refuse the claim for failure to file on time. As a result, there is an outstanding claim that becomes the responsibility of the supplier.

The purpose of the medical biller is to ensure that the provider is paid for their services. Human and electronic faults are, unfortunately, unavoidable. Because medical billing involves both health and money, it’s critical to eliminate as these mistakes as soon as possible. When an insurance provider denies a claim, a record of the denial is kept in their system. If they reject a claim, they do not maintain a record of it in their system.

Do you get stressed out by the burden of claim follow-up and accounts receivable management? It’s a lot easier to navigate the medical billing procedure when you know the difference between rejection and denial. Let the professionals at Info Hub, an offshore medical billing company, to aid you with your billing needs. On a daily basis, our knowledgeable staff follows best practice payer-specific policies and protocols to assure that your claims are neither rejected nor denied, and that they are paid appropriately and on time.

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Importance Of A/R Follow-Up And Denial Management https://infohubservices.com/blog/importance-of-a-r-follow-up-and-denial-management/ https://infohubservices.com/blog/importance-of-a-r-follow-up-and-denial-management/#respond Wed, 16 Mar 2022 12:31:12 +0000 https://infohubservices.com/?p=45495 Accounts Receivables that are way overdue should be followed up on promptly, along with effective denial management that contributes to the health of a healthcare providers financial strength. The primary purpose of accounts receivable management in healthcare is to increase cash flow in a practice by shortening the collection duration and lowering the associated costs. Is your practice looking for ways to get paid for pending claims, or reopen rejected claims? A dedicated A/R follow-up team can help you with the same.

What is Accounts Receivable?

Money that is due to physician businesses for medical care delivered to patients is referred to as Accounts Receivable (AR). Any payments pending from insurance companies, patients, or other guarantors are included in the accounts receivable process. AR management includes re-filing rectified claims, detecting denied/unpaid claims, minimizing AR days, and removing old account receivables.

Accounts Receivable and Denial Management

Physicians, hospitals, and nursing homes provide an ever-increasing number of services. Patients owe a certain sum to the physicians or hospitals every time they receive treatment and care. A good insurance model aids healthcare organisations in quickly and easily recovering overdue payments from insurance companies. Accounts receivable (A/R) and denial management are necessary in this situation. It enables healthcare service providers to conduct their businesses smoothly and successfully while also ensuring that money is reimbursed sooner.

Understanding the Importance of A/R Follow Up

A medical organization’s accounts receivable follow-up team is in charge of investigating rejected claims and reviewing them in order to collect maximum compensation from health insurers. Medical billing, accounts receivable, and revenue cycle management are handled by billing experts with certain skill sets. A medical billing professional determines the exact procedure code and diagnostic code depending on the treatment plan during other processes in medical billing. In case of errors in adhering to guidelines, claims may be refused; therefore, it is critical to have a dedicated A/R team that can follow up with the insurance providers to address disputed claims.

A/R follow-up management is critical for most firms in the medical billing process. Here are a few of the more common reasons why A/R follow-up is crucial:

  1. Quick Payment of Outstanding Amounts – The primary goal of A/R management is to reduce the amount of time that accounts are permitted to be overdue. The team keeps track of accounts that haven’t been paid, determines the best course of action for securing payment, and executes payments.
  2. Maintaining the Financial Health – Ensuring a positive cash flow is critical to any healthcare service provider’s financial viability. The A/R department takes care to see that the hospital maintains a consistent flow of money in order to cover expenses and provide patient care services.
  3. No Missing Claims – The most common cause of payment delays is the failure to receive a claim. This typically occurs when paper claims are misplaced. It is preferable to send claims in electronic format to avoid this. If you’ve followed up on the claim and know it hasn’t been received, it’ll be much easier to send another request for the claim soon.
  4. Recover Pending Claims – Due to additional information needed for the member, claims are sometimes left pending for a period of time. By appropriately following up, the A/R team can tell the member about the situation, and then take appropriate measures to expedite the process.
  5. Recovery of Unpaid Payments – A/R follow-up assists all hospitals, physicians, nursing homes, and other businesses in recovering past payments without difficulty. It is easier for healthcare providers to obtain reimbursements on time when there is a team that is always involved in the claims follow-up procedure.
  6. Dedicated Follow Up on Denied Claims – You can send a fresh claim request with appropriate modifications made, depending on the reason for denial. The A/R department may ensure that all claims are followed through to the conclusion by calling the insurance providers and figuring out the denial reason rather than waiting for it.

Importance of Denial Management

One of the most critical tasks in account receivable management is identifying claim denials at the appropriate time. Your billing team should be professional and knowledgeable in order to determine the reason for claim rejection and re-fill the claim as soon as possible. It’s also critical to look at denial patterns and come up with specific remedies to lessen the number of denials in the future.

Info Hub, an offshore medical billing company, not only tracks and manages each aspect, but also provides you with complete, real-time visibility into your earnings. Info Hub has been providing medical A/R services with a highly skilled staff of accounts receivable specialists who work with a variety of insurance carriers and are familiar with all of their regulations. We make certain that our customers face no encumbrance in receiving money for the services rendered.

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3 Most Common DME Billing Challenges https://infohubservices.com/blog/3-common-dme-billing-challenges/ https://infohubservices.com/blog/3-common-dme-billing-challenges/#respond Wed, 23 Feb 2022 09:16:01 +0000 https://infohubservices.com/?p=45134 DME billing is complex, and Info Hub, a leading offshore DME billing company in India comes with the required expertise to help increase your revenue. Efficiency is the key to success in any healthcare setting! Your ability to innovate and improve patient experience while lowering costs and minimizing mistakes is critical to your success. To fulfil these objectives, it is critical to have a well-functioning medical billing system in place. With our DME billing services, we leverage our experience, expertise, and latest technology to ensure complete accuracy and competence.

The Durable Medical Equipment (DME) billing sector is continually evolving due to the ever-changing regulatory compliance. Most organizations find it difficult to keep up with the changing DME billing market, which is why offshore DME billing services are a lucrative option. Medical equipment companies confront a variety of issues, including declining collections, billing errors, the cost of training new employees, and operations that are halted due to a lack of personnel. Understanding the various issues that make up a part of DME billing can help reduce these, and have increased returns. Read on below for the most common DME billing challenges.

Policy Violations

When invoicing or payment for services is not in accordance with the written policy, it is considered a policy violation. DME claims sent to Medicaid rather than Medicare or another primary insurance plan. Medicaid is considered the payer of last resort, so payment should be sought from other insurance first.

Coding Errors

Errors in code are another major cause. The claim will be refused if your billing team submits medical documentation with different codes than the ones billed. Typical coding related challenges are –

  1. Using HCPCS codes incorrectly to drive a diagnostic related group (DRG)
  2. For trauma and fracture diagnosis codes, the seventh character is incorrectly applied
  3. Respiratory failure is misdiagnosed
  4. Using guidance tools incorrectly
  5. Inadequate documentation of devices, components, grafting materials, etc

Insufficient Documentation

When a provider’s documentation does not fully support the billed procedure code, it comes under the insufficient documentation error. Common DME claim documentation errors include:

  1. Medical Necessity – It is critical that the evidence demonstrates the treatments billed were medically necessary under Medicare’s coverage and payment policies.
  2. Use of Modifiers – Incorrectly employed modifiers for DME billing can result in claims being denied or rejected. Even a misplaced code can result in a claim denial.
  3. Verification of Patient Data – A common factor is a lack of patient data verification. Claims are denied by the CMS or the insurance provider if there are minor errors in names, or the way forms are filled out.

Without adequate documentation, coders and billers will struggle to enter the relevant information, resulting in claim denials. And, when paperwork is insufficient to support the claim, healthcare professionals not only lose the money, but also the time and effort they put into it.

Ways to Reduce DME Billing Errors

To fix the majority of the faults discovered, there are certain potential practices that can be adopted into everyday billing.

Quality control on services

  1. Verify the equipment or supplies provided are in accordance with documented policy.
  2. Verify the delivery of equipment or supplies is in line with beneficiary or representative signature.
  3. Verify that the completion of environmental modification is completed with beneficiary or representative signature.

Quality control on beneficiary records

  1. Confirm if beneficiary has other insurance as a major payer
  2. Determine a beneficiary identifier on each document.
  3. Double-check the documentation accurately so it reflects the type of DME and quantity delivered.
  4. Check the quantity of units billed as part of the claims processing quality control.
  5. Confirm the procedure or service code is correct, along with the service dates entered on the documentation.
  6. Ensure the claim’s number of units and product description match the documentation’s number of units and product description.

Having a sound team of billers and coders who are familiar with CMS guidelines and regulations can help in timely and accurate DME claims. Offshore DME billing services have the required resources at disposal and are responsible for a knock in profits if they use incorrectly coded modifiers. Given the difficulties and complexities of DME billing, many providers opt for offshore DME billing companies. By offshoring their billing, they gain access to a team of highly trained coders and billers that are dedicated to delivering timely payments, minimized errors and increased collections.

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End-to-End Guide For DME Billing Services https://infohubservices.com/blog/end-to-end-guide-for-dme-billing-services/ https://infohubservices.com/blog/end-to-end-guide-for-dme-billing-services/#respond Thu, 27 Jan 2022 08:23:48 +0000 https://infohubservices.com/?p=44941

Durable Medical Equipment or DME has undergone regular renovations over the years due to changes in regulatory compliance. Constantly changing the DME billing landscape always creates so many challenges for the medical equipment suppliers and medical practitioners. DME contributes to approximately 2% of Medicare’s annual expenditure. Then denials are some of the stressful reasons for healthcare professionals while billing Durable Medical Equipment.

Not all DME billing claims will return proper revenue reimbursements for healthcare professionals. DME billing has the maximum denials than any other field in the healthcare services. Its due to various reasons and factors but all these denials cause major damage for revenue payments in the revenue cycle management process.

Some other concerns faced by DME providers, such as fewer collections, billing errors, training expenditure for new staff, discontinued operations in the absence of office staff. DME billing needs proper attention and concentration. Even the smallest mistake can lead to very slow productivity and revenue halt.

What is DME billing?

  1. Durable Medical Equipment is therapeutic equipment prescribed by a licensed healthcare practitioner to patients suffering from certain medical conditions.
  2. DME billing covers only if the equipment is used for prescribed medical conditions and not for convenience and beyond reasonable requirements of the patient.
  3. Examples for DME are Nebulizers, Ventilators, Kidney machines, etc. DMEs are mostly meant for therapeutic benefits for those patients suffering from chronic conditions or long term illnesses.
  4. Yet, it may or may not be useful for patients without any chronic diseases too. DME is durable and the time period can be more depending on the sickness of the patient.

What is DME Coding?

  1. DME billing agencies, data analysts, and coding experts use a customized DME coding system that puts a track of all codes in DME billing services.
  2. DME coding helps the distributors and vendors keep track of DME billing services efficiently so that claims won’t be missed and will be fast tracked. It’s important to learn that the coding system for DME cannot be a substitute for HCPCS releases.

DME billing Services in a Gist

  1. Right after the invoice is created, it’s the most important or necessary step to pile up those documents and medical records for electronic claim submission.
  2. A deep check of the documentation is important before the electronic claim submission. The document needs to be error free and clear with complete information provided with essential details.
  3. If any documents go missing, there are denials ready to shoot healthcare professionals or if the claim falls under non-compliance.
  4. Many healthcare professionals prefer outsourcing DME billing services to prevent denials and revenue losses.
  5. Medical billing companies usually focus on the documentation and medical records to make sure the claim is ready to go for a submission.

DME Billing and Insurance Coverage Indications

  1. DME billing services can be covered if the patient has DME benefits and the equipment is prescribed by the healthcare professional for a specific long term condition, disease, or illness. The equipment has an exception to exclude in the patient benefit plan document or history.
  2. For DME billing, DME must not be consumable unless necessary for effective use of covered DME.
  3. Patients cannot use DME unless there is a severe disease illness or disability.
  4. DME must be provided or should order by healthcare professionals for outpatient use in-home settings.
  5. DME must be used only for medical purposes or medical use.

DME Billing Coverage Limitations and Exclusions

If there is one or more DME to meet the functional need, coverage benefits are applied and available only for one DME with the minimum specifications for patient requirements such as:

  1. Standard power wheelchair Vs custom wheelchair
  2. Standard bed Vs semi-electric bed Vs complete electric or floating bed

This limitation is specifically meant to eradicate coverage for deluxe or additional components for a DME item and is not much required to meet the minimal specifications of patients to treat the chronic disease or illness.

When a patient buys or rents a DME surpassing the mentioned guidelines, the patient is held responsible for the cost difference between the items or devices purchased or rented.

The DME billing services excluded from coverage include:

Accessories or devices that are included in the DME services are mainly meant for the patient’s comfort and convenience. Here are some DME devices that are not covered by insurance companies:

  1. Air conditioners
  2. Air purifiers and filters
  3. Batteries for non-medical equipment
  4. Humidifiers
  5. Non-medical mobility devices.

These exclusions are not applicable for Pediatric DME billing coverage.

Covered DME Billing Services

DME billing services or healthcare services including supplies or pharma products to decide the following:

  1. DME is provided for preventing, evaluating, diagnosing, and treatment of a chronic disease or illness, injury, mental illness, addictive disorder.
  2. DME that’s medically necessary.
  3. Not excluded and described under covered services.

We hope you now have an idea of DME billing services.

With DME billing outsourcing to Info Hub, you get to partner with a reliable offshore DME billing company that is overly focused on simplifying your billing process and assuring that you receive accurate compensation in the shortest possible time.

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