Denial Management is the process of systematically investigating each denial, performing root cause analysis to determine why each claim was denied, analyzing denial trends to identify a trend by one or more insurance carriers, and redesigning or re-engineering the process to prevent or reduce future risk. How would you rate your ability to work a denial effectively and efficiently when the average claim denial appeal costs upwards, which can amount to a six-figure annual expenditure for some healthcare organizations, when you consider the additional cost of write-offs, you can see why provider organizations value medical billers with exceptional denial resolution skills.

Lack of effective denial resolution is a common failure of medical practices. Maintaining good control of denial resolution is best accomplished by reviewing the denial reason codes on a regular basis to determine why the claim was denied and making corrections to avoid similar denials in the future. Running and reviewing a denial reason report at least monthly is one of the most efficient ways to stay on top of denial resolution. Once the reasons for the denials have been identified, review current office processes and eliminate the errors that caused the denials.

Erendiz Academy and Denial Management Training:

With Erendiz Academy’s Denial Resolution Course training, you can clear certification exam and can play a significant role in optimizing your office’s revenue cycle. This advanced training for billers and other medical professionals covers the most recent billing and claim denial information. Students will learn how to track claim judgments, understand different types of denials and how to resolve them, as well as key aspects of the revenue cycle. The Denial Resolution course includes a thorough examination of the claims submission and processing procedures. It addresses a variety of rejection codes. The training covers organizational strategies and processes, making it ideal for coders, billers, and practice managers. The CMS-1500 and 837p claim forms, as well as clearing house reports, are examined.

What are different types of Denials?

In general, Denials are divided into four categories which are Demographic denials, Coding Denials, Benefits of Denials and Backend billing denials.

• Demographic Denials: Demographic denials are caused by failure to collect and report a patient’s demographic information accurately.
• Coding Denials: Coding denials are caused by coding errors, date inconsistencies, and incorrect code pairing.
• Benefits of Denials: Denials of benefits based on authorizations, pre-certifications, medical necessity, or covered services are examples of benefit denials.
• Backend billing denials: Backend billing denials can be because of a Duplicate claims, missed deadlines, failure to follow procedures, and omission of important requested documentation.

Obtaining a Denial Resolution and Management credential demonstrates:

• Review of the revenue cycle for the medical office
• Proper claims completion for the CMS-1500 claim form
• Review of clearinghouse reports and explanation of benefits (EOBs)
• Common denials and steps to resolve the denials
• Case Studies for practical application of denial resolution
• Interactive lectures covering the healthcare revenue cycle, denial resolution and CMS-1500 claim form
• Denial Resolution final assessment

AAPC’s Denial Resolution and Management New Exam Structure:

• 35 multiple-choice questions (proctored)
• Coding cases from real-world, redacted records
• Must be completed within 75 minutes
• 70% passing score required