Denial management refers to the process of identifying and addressing denials that occur during the medical billing and claims process. Denials occur when an insurance company or other third-party payer rejects a claim for payment, either due to errors in the claim or because the services provided were not covered under the patient’s insurance policy.

Denial management involves several steps, including:

Identifying denials: This involves tracking and analyzing claims that have been denied, identifying patterns and trends, and determining the reasons for the denials.

Investigating denials: Once denials have been identified, the next step is to investigate the reasons for the denials. This may involve reviewing the claim to identify errors or omissions, or communicating with the insurance company to determine why the claim was denied.

Correcting errors: If errors or omissions are identified, the next step is to correct them and resubmit the claim for payment. This may involve working with the healthcare provider or facility to ensure that the necessary documentation is included with the claim.

Appealing denials: If the claim was denied due to a lack of coverage, the healthcare provider or facility may need to appeal the decision. This may involve providing additional documentation or arguing that the services provided were necessary and should be covered under the patient’s policy.

Effective denial management is important for healthcare providers and facilities, as denials can result in lost revenue and increased administrative costs. By identifying and addressing denials in a timely manner, providers and facilities can improve their revenue cycle and ensure that they are being reimbursed for the services they provide.