Outsource Denial Management Services to the Experts Through Robust EHR Support 

Denial Management Services
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It’s no secret that healthcare costs in the United States are on-the-rise. A lot of people don’t realize that one of the major contributing factors to that are denials – something that causes headaches for providers and patients alike.

According to one recent study, an incredible 89% of all hospitals and health systems saw a spike in denials in the last three years alone. In 2021, there were an estimated 48.3 million denied claims. Research from Experian even indicated that most healthcare leaders say denials are increasing at a rate of between 10% and 15% depending on who you ask – pointing to a problem that is only going to get worse before it gets better.

Thankfully, modern technology has advanced to the point where “getting better” isn’t nearly as difficult as it once was. With cutting-edge software and a partner like PrognoCIS at your side, you can finally free up a lot of the money that was being monopolized by your claims management process so that it can be funneled back into other areas of your practice where it can do the most good. This is true in a wide range of different ways, all of which are worth exploring.

How PrognoCIS Lowers Your Denial Rate?

In an over-arching sense, PrognoCIS was designed to be more than just another Advanced EHR solution. It’s a chance to leverage technology to your advantage, using it to optimize workflows at your practice, increase revenue, cut costs, and most importantly improve the patient experience. It includes electronic health record functionality, practice management tools, patient engagement features, integrations, dashboards, and more.

As it specifically relates to denial management, the overall value of PrognoCIS can be summed up in a single word: visibility. From the moment of deployment, we can work directly with your analytics so that you can better understand the intricacies of your claims process.

It’s not just about knowing WHAT is happening. You also need to know WHY, all so that you can take the necessary action in the moment.

  • PrognoCIS can help you quickly identify those areas where a denied claim might be an issue, for example. We can proactively correct your workflow before the claim is ever filed, thus preventing it from getting denied in the first place and lowering your overall denial rate.
  • When a claim does get denied, one of our trained and experienced EHR support staff members will go through the appeals process to figure out what went wrong and how to correct it. It is our duty to make sure your claims are paid by the insurance carrier in full.

More than anything, we understand how time-consuming denial management can be. We want to free up as much of your time as possible so that you can devote 100% of your attention to your patients and running the most successful practice that you can. We do this so that you can rest easy knowing that denial management, revenue management, and other core areas of your practice are running as smoothly as possible.

Denial Management Practices We Follow

Although we acknowledge that every practice is unique, there are still a number of important elements of the denial management process that we assist with on a daily basis. These include but are not limited to things like:

  • First, we get to work on identifying your practice’s current denial situation. We do this via reports, denial management software, payer remittance advice, and more. The goal is to paint a complete picture regarding where you are and where you need to be.
  • At that point, we categorize denials based on all available information. Soon, common reasons will begin to emerge. If you have a lot of denials due to missing documentation, for example, or for coding errors that are consistently taking place, we know exactly which areas to focus on.
  • We then pour over denial details, analyzing everything to again fully understand exactly what is going on. We make sense of denial reasons, payer requirements, and more. We then gather any missing or required documentation like medical records or prior authorizations.
  • We go through the appeals process on your behalf. We’ll submit the appeal, track it, follow up on it when required, and escalate it if needed. Once everything is done, we generate reports so that you can get insights into areas of the process where you could use improvement. That way, you’re in a better position to proactively prevent those denials in the future.

The Advantages of Denial Management Services

The major advantage of denial management services is that they help cement a practice’s financial stability over time. When a claim gets denied, it means that a practice isn’t getting paid for services that have likely already been performed. All that time and all those resources are gone. Being a provider with a sky high claims denial rate is also not a reputation you want to develop as it could turn off patients before you know it through poor word-of-mouth.

Healthcare Denial management services, on the other hand, allow you to more efficiently manage claiim denials. This helps you increase collection rates, making sure that revenue is always at the level you need it to be. This also helps create a smoother process for patients as well, boosting their satisfaction across the board.

Denial Management Trends

According to another recent study, the global healthcare claims management market size hit an enormous $21.64 billion in 2021 alone. The only thing more impressive than that is the fact that it is supposed to grow at a rate of about 23.4% per year between now and the end of the decade.

The claims management process is infinitely precise and time-consuming, but it is also critical for your practice’s ability to generate revenue. This, coupled with the fact that so many denied claims are avoidable, help underline exactly why so many professionals are turning to modern technology like PrognoCIS to make things easier. The more time they can save, the better off patients are. The more money they can save, the better their practice is. Costs go down, the quality of services go up. That’s not only why EHR solutions have become popular for denial management and other tasks, but why they will continue to be so moving forward.

The Advantages to Medical Providers

Again, the major advantage of denial management services to medical providers is that it creates a stress-free environment where medical professionals can worry less about the “business side” of their practice so they can devote all their attention to offering critical care to patients.

By design, denial management experts like PrognoCIS combine experience and analytics to optimize denial management across the board. A team of dedicated professionals is handling everything accurately and efficiently.

Your staff’s invaluable time is then freed up to focus on carrying forward your practice mission. Organizational leaders also don’t have to worry so much about the future – meaning whether they’re actually going to get paid for services that have already been performed. They can be in the present, making decisions based on the precise care people need as opposed to if and when they will get paid for it.

PrognoCIS: The Most Trusted Denial Management Services Company

At Bizmatics, we designed our PrognoCIS ERA solution from the ground up to be the specialized software you need to scale your practice. In addition to denial management solution we also offer pain management, revenue cycle management, chronic care management, medical credentialing, and more. But most importantly, we offer a solution that can be fully customized to play to the unique strengths of your practice, not anyone else’s.

We want you to be able to break free of the “one size fits all” approach to technology that is so often found in healthcare. Rather than forcing you to work with the tools everyone else has, we want you to be able to build something that is as specific and unique as you are – exactly the way it should be.

If you’d like to find out more information about the importance of denial management services, or if you’d just like to go over your practice’s own requirements with someone in a bit more detail, contact the team at Bizmatics, Inc today.

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We look forward to exploring the potential benefits and offers prognoCIS has for you.

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