How Outsourcing a Team of Denial Management Specialist Help in Business Recovery

Medical claim denials are one of the most common barriers to effective revenue cycle management (RCM) as inadequate management of these can lead to revenue loss, additional costs, and slowing down cash flow. According to a report by the American Academy of Financial Physicians (AAFC), the average denial rate across the healthcare industry is between 5 to 10 percent with below 5% being the more desirable rate indicating that a provider has healthy cash flow.

The Center for Medicare and Medicaid Services has stated that 30% of claims are either denied, lost, or ignored. This is where denial management specialists come into picture. They are the ones who have the duty to review and resolve denied patient insurance claims and appeal for possible reimbursement. Building an in-house denial management team can be quite taxing especially to resources and time, which is why outsourcing is highly recommended due to its multiple advantages that can help your business especially in times of crisis:

Access to World-class Talent

Outsourcing denials management means you have access to a pool of trained professionals who have extensive experience and insight on important subjects such as claims submission and appeals, standard coding rules, and NCD and LCD policies that determine which healthcare services will be covered by Medicare on a national and local level, respectively. This does not only prevent denials but also help you avoid getting into the same situation in the future.

Since these professionals already have the knowledge needed, you are guaranteed that they can do their jobs properly without the need for training or orientation which contributes in cutting costs while still delivering quality service. With this, you and the rest of your staff can focus on providing care to patients.

Their access to world-class talent coupled with their A+ recruitment process can build you a dedicated team of Denial Management Specialists and Revenue Cycle Managers (RCM) in only 30-45 days from hiring to on-boarding.

Limit Denial and Claims Errors

Incorrect coding, whether it’s using a mismatched ICD or outdated CPT code or entering incorrect patient information, is considered to be one of the common reasons for denied claims according to the 2013 MGMA Health Insurer report card. By having a dedicated team of denial management specialists to thoroughly filter claims, these errors can be fixed and prevented, saving you the trouble and high costs of dealing with initial denial or rejected appeal. 

Just to provide a better picture on why reducing errors is important, a study by the American Medical Association (AMA) found that practices spend approximately $15,000 every year on reworking claims, including phone calls, investigative work, and claim appeals.

Improved Cash Flow

Ultimately, strategic denial management is the key to a healthy cash flow. You can achieve this by opting to outsource a team that will focus on tracking and processing claims and identifying common causes of denied claims in your business. Through this, you will be able to avoid revenue loss, make guided business decisions that can prevent future denials and lower your denial rate.

Sense of security and peace of mind from a Net Promoter Score of >60

Operational excellence is measured by a Net Promoter Score of >60. This is a result from a survey answered by their clients on how much they are willing to promote their outsourcing partner. If the score is >60, it means that they were able to receive outstanding quality service and the level of satisfaction they have with the partnership. To put it simply, if you partner with an outsourcing company with an NPS of >60, you have a sense of security that the services they are providing responds to your unique needs and pain points which in return give you peace of mind to allow you in focusing on achieving your business goals as they focus on denial management.

Look for a trusted outsourcing company that can help you build a dedicated denial management team. In return, you are guaranteed with: 

• Operational excellence
• Build a dedicated team of denial management specialists and RCM team that can help you properly manage claim denials
• Operational cost savings of up to 70%
• 95% coding, billing and documentation accuracy
• 90% ROI through accurate claims
• Improved denial management rate
• ISO 27001 and 9001 certified, GDPR, HIPAA compliant
• 71 Net Promoter Score: Sense of security and peace of mind

Connect to a world-class pool of talent all the while saving up to 70% operational cost without compromising quality of work and maintaining operational excellence by finding the right partner. The right partner also has an established Information Security in place to ensure patient data confidentiality regardless if working on-site or remotely. 

Infinit-O is the trusted customer-centric and sustainable leader in Business Process Optimization to Small and Medium businesses in the Financial Services, Healthcare and Technology sectors by delivering continuous improvement through technology, data and people.

For a free business consultation, you can schedule an appointment here.