Denial Management

MS Revenue & RCM Automation is dedicated to minimizing lost reimbursements and denials through highly efficient systems and services designed to meet our client's needs. One major problem faced by healthcare providers and medical billing companies is that a significant proportion of denied claims go unattended and are never resubmitted. Our Denial Management process uncovers and resolves the root causes of denials, shortening the accounts receivable cycle.

Our denial management team establishes trends between individual payer codes and common denial reason codes. By tracking trends, we identify weaknesses in billing, registration, and medical coding processes, which are then corrected to reduce future denials and ensure that claims are accepted on the first submission.

Additionally, we analyze payment patterns from various payers to set up mechanisms to alert us when deviations from the normal trend are observed. For denied claims that need to be appealed, we prepare appeal letters and submit them along with supporting documents, including medical records, for processing. We also handle patient follow-ups to obtain missing information, discuss outstanding dues, and ensure timely collections.

Furthermore, we conduct credit balance audits during the collection retrieval process to reconcile unidentified and duplicate payments. Payer and patient overpayments are refunded or adjusted as per each client's policies, and refund requests are prepared and sent to the clients after thorough research of the patient accounts to establish overpayments.