Hospital / Physician Denial Management Services
Identify and win more claim denials with denial management software. The integrated denial management service categorizes denials based on historical trends, so your staff will spend time appealing denials that have a real chance of being overturned and increasing your collection rate.
Learn more about denial management today!
Managing the Variability
Currently, under the HIPAA guidelines, there is a standard set of reason codes (ANSI Claim Adjustment Reason Codes (CAS)), but each payer has a different set of reasons for which it denies. PMMC utilizes these codes as the standard and works to translate any denial that occurs into this data set by payer.
Seamless Integration to Target Problem Areas by Payer
Easily capture ANSI Claim Adjustment Reason Codes (CAS) and Payer Remark Codes through an efficient 835 transaction set import routine. This allows the system to integrate with existing patient accounting platforms. While there is a standard list of CAS codes, each payer can apply different reasons to the codes. With PMMC’s Denial Management module, the standard CAS codes are established in the system with the flexibility of identifying the corresponding reason by payer.
Accelerate the Identification and Resolution of Denial Issues
PMMC’s Account Management functionality provides the ability to group denial code types and denial categories. Denial Types are used to categorize and prioritize the denial and appeal process. These include Soft, Hard, Clinical and Technical/Administrative denial categories. There is also the ability to define the hierarchy of the denial and reason codes (primary/secondary/etc.). This improves the workflow process / data presentation in Account Management and Reporting. By Categorizing medical billing Denials, your staff can spend time appealing denials that have a real chance of being overturned, increasing your collection opportunity.
Measuring and Managing the Process
Denials often follow variance patterns. PMMC’s Account Management identifies these reoccurring problems for proactive follow up whether that is directly with the payer or internally with process changes. Payer adjustment codes can be analyzed according to client-driven parameters. Findings can be quantified for follow up recovery opportunities or used for managing the workload.
Appeal staff members can easily check the claim and appeal status, document all interaction with the insurance company/patient/responsible party and produce appeal documentation. Activity can be tracked and reacted to. Coupling the system with your coding staff, you will be able to minimize denial write-offs and improve your bottom-line.