Denial Prevention

TriumpHealth offers Denial Prevention & Management services to help healthcare providers minimize claim denials and increase their revenue.

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MEDICAL BILLING & REVENUE CYCLE MANAGEMENT

Denial Prevention

Based on our experience working with physicians and healthcare organizations we understand that the revenue cycle success starts at the patient registration and continues throughout the claims cycle. Accuracy of patient demographics and financial information up front results in reduced denials, fewer rejected claims, and fewer returned statements. Claim cleanliness is the key component that stops the denial from origination, and it is impacted by the following parameters:

Patient registration data quality
Prior-authorizations
Non-covered services and medical necessity management
Eligibility and benefits coverage
Clinical documentation quality
Coding
Claim editing
Payer rules & mandates

TriumpHealth supports your healthcare organization with denial prevention capabilities and best practices. We assist you in identifying root causes for errors in the front end of your revenue cycle, which therefore improves the downstream process. In addition, we help in checking the medical necessity requirements and creation of necessary ABNs, resulting in reduced denials and faster payments.

Frequently Asked Questions

What is denial prevention in healthcare billing, and why is it crucial for the financial health of medical practices?

Denial prevention in healthcare billing refers to proactive measures taken to minimize the occurrence of claim denials, ensuring timely reimbursement and financial stability for medical practices. It’s crucial as denials can result in revenue loss, increased administrative costs, and disruptions to cash flow, impacting the overall financial health of the practice.

How do you identify common causes of claim denials, and what strategies are implemented to prevent denials from occurring in the first place?

We identify common causes of claim denials through thorough analysis of denial data, including coding errors, incomplete documentation, and payer-specific requirements. Strategies to prevent denials include staff training on coding accuracy and payer guidelines, implementing automated claim scrubbing software to catch errors before submission, and establishing robust quality assurance processes to review claims prior to submission.

Can you explain the role of accurate medical coding and documentation in denial prevention, and how do you ensure compliance with coding standards?

Accurate medical coding and documentation are essential in denial prevention as they directly impact claim acceptance and reimbursement. We ensure compliance with coding standards by staying updated on coding changes, conducting regular audits to validate coding accuracy, and providing ongoing education and training to staff on proper coding practices and documentation requirements.

What tools or technologies do you use to proactively address potential denial risks and improve the accuracy of claims submissions?

We utilize advanced technologies such as claim scrubbing software, electronic health record systems, and predictive analytics tools to proactively identify potential denial risks and improve the accuracy of claims submissions. These tools help flag coding errors, missing documentation, and other issues before claims are submitted, reducing the likelihood of denials and streamlining the revenue cycle process.

How do you handle denial trends or patterns, and what measures are taken to implement corrective actions for sustained denial prevention?

We analyze denial trends and patterns to identify root causes and implement corrective actions for sustained denial prevention. This may involve targeted staff training, process improvements, payer communication to clarify requirements, and ongoing monitoring and adjustment of denial prevention strategies. By addressing underlying issues proactively, we aim to minimize denials and optimize revenue cycle performance over time.

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Our Process

Comprehensive Documentation

Ensure accurate and thorough documentation of patient encounters, including diagnoses, procedures, treatments, and any relevant clinical information, to support claims submitted for reimbursement.

Coding Accuracy

Implement robust coding practices and regular training for staff to ensure accurate assignment of medical codes, adhering to coding guidelines and payer requirements to minimize coding errors and denials.

Eligibility Verification

Verify patient insurance coverage and eligibility prior to providing services, confirming coverage for planned procedures and treatments to avoid denials due to insurance-related issues.

Claims Scrubbing and Pre-submission Review

Conduct thorough reviews of claims before submission, using automated claims scrubbing tools or manual checks to identify and address potential errors or discrepancies that could lead to denials.

Top Rated by Healthcare Organizations

TriumpHealth has helped us with MU  and PQRS since 2013, and now MIPS. TriumpHealth has worked well for us because of their systems and compliance knowledge.
Having TriumpHealth support us in these efforts keeps my office staff focused on the patients. For any clinic stuck using Allscripts,  TriumpHealth can help.

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We will help you achieve financial and regulatory compliance goals resulting in improved patient outcomes and increased revenue.

Denial Prevention