CureMed Solutions

Rejections & Denial Management

Rejections & Denial Management

A recent survey from Harmony Healthcare reveals that the healthcare industry has seen a 20 percent increase in claim denial rates in the past five years. The survey of 131 hospitals revealed that 33 percent of hospital executives reported average claims denial rates of 10 percent or more, a figure that indicates hospitals are nearing a “denials danger zone.

A transparency data released in 2020 by the Centers for Medicare and Medicaid Services (CMS) to examine claims denials and appeals among issuers from plan years 2018 and 2019 also reports about 17% of in-network claim denials in 2019, and about 14% of denials by issuers in 2018, with rates for specific issuers varying significantly around these averages. These findings make us believe that hospital claim denial rates are reaching an all-time high, signaling a need for better claims denial management.

Rejections & Denial Management

At Curemed solutions, we have a team of dedicated and skilled professionals who work with you to handle your claim denials and rejections productively, promptly and successfully. Here’s how we assist you:

  • We evaluate your data on a daily basis to check for any EDI/Payer rejections and denials.
  • Our experts analyze in detail the entire data of all your denied/rejected claims to identify the key causes and categorize them for appropriate remediation by our multidisciplinary denial management team to make necessary corrections to the data such as inaccurate medical codes, provide supporting clinical and other documentation, or seek additional clarification or information from the client.
  • We also prepare appeal letters accordingly to refile the claims by attaching clinical documentation and submit the claims in a payer-specific format.
  • Our team of denial analysis experts evaluate the data to recognize the patterns in the denials/rejections. They study in detail the top trends in your data such as top denial/rejection categories, top insurers which deny payments, top service area which are impacted by the them etc. to devise a permanent solution for such categories.
  • We also provide a detailed report to you with our feedback on the trends and patterns around your denials and rejections. This feedback includes results from root cause analysis and financial impact analysis of the denials and measures the impact of process improvements or rectification of processes at your end.
How outsourcing these services to us benefits your practice?
  • Overturned claims boost your cash flow immediately leading to a more productive revenue cycle.
  • Trends report helps identify key areas for process improvement and prevent future denials.
  • Rapid claim reprocessing services, within 24-48 hours, without compromising on the quality.
  • 100% compliance with HIPAA and data security provision
  • Efficient services at highly competitive pricing, also eliminating the cost you would incur on maintaining resources at your end.
  • To focus on preventing denials in essential categories pertaining to coding systems, eligibility/ authorization and medical necessities, we also offer comprehensive services for entire revenue cycle management.