Denial Management Services

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​At Claims Med, we find that to ensure efficient revenue cycle denial elimination through proper denial management is imperative. In the health care industry payers often find reasons to underpay, deny or delay payments. Not only do we appeal denials but we also track and analyze patterns that lead to this problem so that it can be addressed early on. The procedures and processes that we have in place ensure maximum reimbursement to your practice

Claims Med specializes in claims consulting to healthcare providers and provides your practice a unique facility for re-imbursement of your pending payments. If you’ve pending payments to different carriers due to errors in billing we will recover those payments for you. Our experienced claims consultants will carefully assess every detail of your claim and the insurance carrier's denial, in an attempt to determine the most appropriate and effective action to be taken on accounts placed with us. Further, we will research the most recent case and statutory laws, which support payment on your insurance claims.

Overview

We do pre-collections follow up for claims which have "reject/resubmit" status and have aged beyond 60 - 90 days and are not ready to be assigned to collections. We believe that there is significant value in pursuing these types of claims on behalf of your healthcare facility, particularly in the wake of resource limitations that can prohibit your facility from processing these claims with the same timeliness as the newer claims.

In spite of timely payment rules in many states, a common complaint of all hospitals is difficulty in collecting accounts, which are 60 to 90 days old. Many hospitals have a difficult time reprocessing such claims.

Our goal is to lessen the burden of un-collectible accounts on your facility's financial health. We facilitate our customers with following services;

Denial Analysis and Follow-up:

At Claims Med we have a complete solution for denial analysis and for their follow-ups. We conduct thorough analysis of every denied claim, make the necessary corrections, and follow-up to convert it into a clean claim. We help you in improving your revenue realization. We help you to introduce every possible preventive measures for your future billing. We maintain a Turn around time of 48-96 hours for denials.

Insurance Follow-Up​​

We run aging reports to categorize (Oldest to Largest & Highest to Lowest) outstanding claims and follow-up with particular insurance carriers. We help our clients in improving revenue realization. Our team of experienced professionals helps you to reduce Days Sales Outstanding (DSOs). We maintain a Turn around time of 45-50 days for DSOs

Patient Follow-Up​​

At Claims Med we follow-up with the Patients for outstanding payments. We help in improving your revenue realization.  We help in timely recovery of payments. Timely follow-up with patients helps reduce bad-debts and maintain better customer relations.

Benefits

• An alternative to immediate collection agency placement
• We successfully secure full benefits of claims previously denied
• Provider can maintain good patient/provider relations
• Overall improvement of financial performance, cash flow and profitability

Solution

Collection of these accounts typically requires:

• Submission of medical or operative records
• Patient completion of coordination of benefits or other forms
• Correction of improper billing information
• Re-submission to the proper carrier

Two-pronged strategy would be adopted

• To gather denial/rejections details, reasons etc through follow ups
• To take appropriate actions, i.e. re-filing of claims etc

Follow Ups
We track denials, log what has been denied, why, how, and when the claim was filed to the greater levels
of details.

Keeping in view electronic transactions standards (276/2777) of HIPAA, we will get to the bottom of the claims status, & then will hit the claims accordingly which may include knowing:

• Pre-adjudication (accepted/rejected claim status)
• Claim pended for development (incorrect/incomplete claim(s) within adjudication process) or suspended claim(s) requesting additional information
• Finalized claims. Further defined, finalized claims may have outcomes that include finalized rejected claim(s), finalized denied claim(s), etc.

It should be kept in mind that denials out of medical necessity (miss-coding of claims) will be easy to handle and collect. The denials due to timely filing and incorrect or incomplete information can turn out to be more problematic, especially for claims of a year old or more. 

Re-filing of Claims
Reviewing of the reasons for denial, making necessary changes and resubmitting the bills.

For more details please call us at (713) 893-4773 or send us email at info@claimsmedinc.com.