Medical Claims Denial Management and Collections

MEDBTS is leveraging AI automation to address claim denials, payment delays and collections before the problems exist.

Medical Claims Denial Management

Claims denials have a cascading effect on the healthcare providers’ overall financial performance. For starters, it stifles the availability of funds necessary to pay wages and cover other costs such as utility, supplies, and so on. It also makes it difficult to invest in new equipment or services. Furthermore, the practice will have to devote additional time and money towards reviewing each denial, determining whether it may be appealed, and, if so, researching and refiling it. These are extra costs incurred simply to get reimbursed for care that has already been provided, making the claims denial management process a cost center for the practice.

While it is unrealistic to assume that all claims will be accepted as-is, with no rejections, it is a very realistic goal to decrease unnecessary denials to fewer than 2% of all claims. To do this, a full understanding of the sorts of denials, how and where the difficulties emerge, and then designing a denials management strategy will be required.

Medical claims denial management is one of MedBTS‘s core services. We integrates claims denial management into the earlier stages of the RCM process by using claims denial specialists as claims submission auditors; this is part of our QC process.

Denied medical claims typically fall into the following categories of causes, beginning with the most frequent of causes:

  • Prior Authorizations
  • Issues with eligibility
  • Inaccuracies in coding
  • Incorrect modifiers
  • Failure to meet submission deadlines (timely filing)
  • Inaccuracies in patient information or claim data

MedBTS coders are trained to proficiently understand each of the the above causes which is key to mitigating the impact of denied claims on a practice’s operational and financial performance.

Medical Debt Collection

MedBTS knows the complexities of the modern healthcare sector, its billing systems, and the technology needed to facilitate all of it. MedBTS claims collection specialists will handle the patients’ accounts that are late or that have gone delinquent by stepping through a thoughtfully crafted process flow; our goal is to collect on past due accounts without disrupting the patient/provider relationship dynamics.

MedBTS‘s early engagement and constant monitoring of provider collection accounts will allow your personnel focus on what they do best, making your billing department’s efforts easier to manage as in-house collections work diminishes.