Denial Management Services

Denial management in medical billing refers to the strategic process of analyzing, correcting, and preventing claim denials. A claim denial occurs when a payer, like Medicare or a commercial health insurance company, declines to honor a provider's request to be reimbursed for medical care.

Denial Management is the process of systematically investigating each denial, performing root cause analysis of why each claim was denied, analyzing denial trends to uncover a trend by one or more insurance carriers, and redesigning or re-engineering the process to prevent or reduce the risk of future claim denials.

Many physician practices forgo thousands of dollars annually in revenue through denied healthcare claims. These denials typically stem from a lack of strong denial management policies and procedures.

Types of Claim Denials

Though all denials result in your physician practice losing out on money you’re owed, they primarily fall under five main categories:

  • Soft Denial: A temporary or interim denial that may be paid if the practice takes corrective action; no appeal is needed.

  • Hard Denial: A denial resulting in lost or written-off revenue; an appeal is required.

  • Preventable Denial: A type of hard denial due to a practice’s action or lack thereof, typically because of registration inaccuracies, invalid codes, and insurance ineligibility.

  • Clinical Denial: Another type of hard denial, though it is due to lack of payment for medical necessity, an appeal is necessary.

  • Administrative Denial: A type of soft denial in which the payer notifies the physician practice exactly why the claim was denied; an appeal is possible.

Medquik Solutions automate processes in the denial management cycle to streamline your revenue cycle management by identifying patterns of denials and underpayments from payers. Medquik Solutions is a far more effective way to increase reimbursement than the outdated manual processes that are so common. Schedule a demo today.