A big part of an efficient medical billing process is what is called “denial management” or “denial resolution”. This is where most offices falter and lose money. Denial resolution is an important step that is often overlooked by doctors and staff because what happens is, claims will be rejected by insurance companies and then “stack up” over time if someone isn’t on top of them daily, reviewing and correcting issues, and resubmitting them.
There several main reasons a claim is rejected. Usually, it has something to do with either using outdated medical codes, or the patients contact info doesn’t match what the insurance company has on file. With the traditional set up, there are staff members in the office that are tasked with trying to keep this information up to date, as well as trying to stay educated on all the new medical codes that get released by the government. In fact, the number of codes will be almost double what they are now by Oct 1, 2014!
The good news is, our iClaim system makes these issues a thing of the past. With regard to the patient’s contact info, insurance status, etc., our system can automatically pull data directly from the insurance company and create a patient chart with one click! This means, not only do you get up-to-date name, address, etc. but you also see immediately if the person’s insurance is current, co-pay amounts, etc.
Now, going back to the medical codes. We have the entire database of codes in our system with all updates/additions/deletions being done by ABS (not you) automatically! So you are always up to date and will usually know more about updated codes than the doctor and his/her staff will know!
You may be thinking, “Why would a doctor even need me if iClaim is so awesome?” The answer is simple: Doctors and their staff have many things they must do throughout the day, removing the billing aspect allows them to focus on quality of care for patients, which is what they would rather be doing anyway.
To understand more about what is involved in denial management, visit this article. (You must sign up for free to read it)