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Denial Management

Reduce claim denials while maintaining revenue inflow

Revesolv has a long history of handling denial management for healthcare providers ranging from big health systems to small businesses. We’ve created a carefully built methodology based on this experience that allows us to go into the data and find the core reason for all denials. We provide a detailed report that emphasizes new as well as reoccurring reasons for denials for individual categories such as a physician, payer, diagnosis, and CPT after we grasp the problem. We develop process enhancements based on this data to decrease denials and maximize revenue. 

Our denial Management Services can Assist you Better. Here’s How to Do It

  • Assist healthcare professionals in recognizing and correcting issues that cause claims to be refused by insurance companies.
  • To make the denial management process easier, classify denials by source, rationale, department, and other distinguishing features.
  • Implement innovative denial management procedures that involve patients and physicians to successfully appeal and reverse unjustified denials.
  • Develop and assess the efficacy and efficiency of various denial management tactics.
  • Maintain current knowledge of the various windows that various third-party payers demand in filing insurance claims to avoid future denials.


Our Service Offering for Denial Management in Medical billing

The denial management team at Medical Billing Wholesalers is comprised of seasoned individuals who:

  • Every allegation that is denied should be investigated.
  • Concentrate on finding a solution.
  • Reply to the insurance company’s request.
  • If necessary, file appeals

We recognize that each denial is unique. We fix erroneous or incorrect medical codes, offer supporting clinical data, appeal any prior authorization denials, understand any actual denial situations so that patients are not held responsible, and successfully follow up. Before re-submission, we re-validated all clinical data.

We work with you as an extended billing office to examine your refused claims and lower the percentage of denied claims over time.


Reduce Denials using Revesolv Strategies

Every organization should take initiative to improve the medical billing process and reduce denials. To reduce the frequency of claims denials at Flatworld, we employ the following strategies:


Determine Patient Eligibility

Our staff is trained to collect information about each patient’s health insurance coverage and eligibility for benefits. Even before patients are admitted, our practice management system can check their eligibility and benefits.


Obtain Prior Authorization

We devise a procedure to ensure that your schedulers include prior authorization for all services that require it. We look into the requirements for prior authorization for in-office services that are most typically required during a patient visit.


Determine Medical Necessity

Insurers may refuse to pay a claim if the diagnosis code provided does not support the need for the service. We employ software that adjusts costs for coverage determinations to avoid this situation. We also collect medical necessity policies from all of your insurers.

Denial Management in Medical Billing from Beginning to End

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Identifying Key Denial Reasons

Our claims denial management services begins by determining the most common reasons for denials and the number of times they have occurred.

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Monitoring And Preventing

We make sure that all claims are analyzed and assessed at this step to avoid revenue leakage.

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Establishing Tracking Mechanism

We focus on establishing a tracking/reporting mechanism for an end-to-end perspective after we categorize the reasons for the denial.

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This phase is used to keep track of denials and route them to the relevant department for corrections and preventative measures.

Why Are We Considered a Denial Management Industry Authority?

To comply with HIPAA and the Office of Inspector General, we follow strict documentation processes.

We take care to use firewalls and secure connection methods including VPNs, SSLs, and encryption techniques.

We provide ongoing training to our employees to ensure that they are up to date and well-versed in the rules that various third-party payers have established.

We conduct frequent and thorough audits of denied claims to determine the type of problems that occurred throughout the submission process and to prevent future denials.

Our knowledge allows us to give the most accurate denial analysis to our clients, allowing them to take swift action to recover monies from refused claims.

To assess remittances and alert clients on probable denials, hidden difficulties, and cash opportunities, we use advanced analytics capabilities.