Denial Management

We at Promantra understand that a good denial management service requires systematic gathering of the required data to eliminate denials. Working denials is like pumping water from your basement when a pipe bursts. Denial management is about fixing the pipe so you no longer need to pump water from the basement.

Achieving powerful results from denial management requires data, data and more data. Our denial management services include process reports and measures all claims that are being denied by your payers. With this level of data, our specialists can fix the issues that are leading to the denials (whether it be issues with the claims or issues with the payers) and stop the torrent of unpaid claims into your medical billing process. Once we do this, revenues for your practice can increase by 10 to 20 percent.

Over the years we have learnt that three elements are typically missing from a practice or medical provider's denial management process: data, filtering/sorting methodologies and feedback to systematically correct errors. Most practices & practice management systems do not properly track denials - at least not in the form in which they are typically used (i.e., they may have the capability, but only if properly implemented and used). The practice management systems that do track denials typically overwhelm the practice with data that is difficult to utilize for high level denial management. Finally, even if the data is captured and can be properly utilized, most practices do not have a systematic way to get the information back into the billing process in a manner that prevents them from occurring again in the future.

At Promantra, we track every denied medical claim and can report this by payer, by CPT, by physician and by diagnosis. This information is presented in a manner that allows fast identification of trends. With this powerful combination in hand, the practice / provider of medical service can then utilize claim rules and edits that are specific enough to dramatically drive up the first pass claim acceptance and stop the flood of denied claims. Our in depth analysis described above also allows payers that are habitual violators of Clean Claim Rules to be identified and pursued. The data and analysis will allow many opportunities for process improvements and revenue enhancement for the practice.

Our Solution helps you optimize your medical billing, speed up your cash flows and hence increase your collections by 20 percent or more. As Denial management is a subsection to Accounts Receivables of any medical facility, we religiously follow the below methodology of managing denials from payers. Our solution is focused around these three key fundamentals:

Prevention

Prevention focuses on actions that can be taken upstream in the patient encounter to prevent denials from occurring in the first place. Prevention can be introduced anywhere in the patient encounter such as: Pre-admit/Pre-registration, Scheduling, Admit/Registration and Billing. Our experts ensure that we track such trends and keep the Client informed periodically about improvements/process changes that can be made across functions.

Analysis

The process of analyzing and aggregating similar denials is strategic in denial management. At Promantra, we understand that analysis and segregation is a forerunner to follow-up process and hence for us it is a fundamental step in denial management.

Tracking and Trend Management:

Besides keeping a track of the denial trend from payers our experts also actively monitor the payment patterns from various payers and set-up a mechanism to alert when a deviation from the normal trend is seen. This is important in understanding the causes of claim denials and enhancing long-term efficiency and drastically reducing lost revenue.

KEY FUNCTIONS OF DENIAL MANAGEMENT:

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