Introduction

Healthcare companies face many challenges when it comes to managing denials. By the end of the year, the total of denied claims and lost revenue can result in noticeable economic harm. To succeed, effective denial management is essential. Denial management is a vital part of Medical billing and revenue cycle management (RCM). To boost efficiency and financial performance, administrative and clinical processes are optimized through RCM. Within the realm of healthcare, this article investigates the importance of denial management in healthcare and develops practical solutions to streamline revenue cycle management processes.

What is denial management in medical billing and RCM?

Investigating, analyzing, and resolving denied insurance claims is part of denial management. It is an essential function for medical billing and revenue cycle management (RCM). Optimizing administrative and clinical processes, RCM improves financial performance and efficiency.

Annually, a substantial loss occurs for physicians due to healthcare claims denied despite proper denial management procedures. Although many denials are recoverable, 65% of claims go unsubmitted. Critical for managing denied claims, effective denial management is part of RCM. Read More...