Consider this fact: medical billing is not just a routine administrative task; it’s the financial lifeblood that sustains every healthcare practice. As per ZipDo, a staggering 80% of healthcare revenue is dependent on effective and professional medical billing practices.
The increasing emphasis on value-based care and alternative payment models will require healthcare providers to shift their focus from fee-for-service to the delivery of high-quality, cost-effective care. This transition necessitates a more precise approach to coding, documentation, and claims submission, as denials may occur when services are not aligned with quality measures.
The ability to effectively navigate and address claim denials is pivotal in safeguarding financial stability, optimizing revenue cycles, and ultimately ensuring the seamless delivery of high-quality patient care. These elements represent crucial facets of the revenue management landscape where accuracy, compliance, and efficiency are paramount.
Among the myriad responsibilities that fall under their purview, one stands out as both a challenge and an opportunity – denials management. It’s a fact that revenue cycle leaders spend a substantial amount of their time addressing and preventing claim denials. This relentless dedication is driven by the fundamental recognition that the revenue cycle is the lifeblood of any healthcare institution.
Claim denial is one of the most complex issues faced by healthcare organizations. Checking and re-submitting claims is taxing and time-consuming. Besides wasting the doctor’s and coding and billing staff’s time, it can be frustrating for the patient as well. “About 48.3 million rejected claims accounted for 16.6% of the total in-network claims submitted in 2021,” spilled out one research.