Navigating Payer Guidelines to Reduce Claim Denials and Enhance Reimbursement

Claim Denial management in the Healthcare industry is considered the most important discipline. As per statistics, Healthcare institutions have denial rates ranging from 5 to 10%. This substantial denial rate results in a substantial amount of revenue loss every year for all medical service providers. It has also been observed that the issue of claim denial generally arises from insufficient claim submission. It is also important to notice that nearly 65% of the denial claims are never resubmitted, which is quite concerning. All these result in a substantial amount of revenue loss to healthcare providers. Denial management is a major healthcare discipline that involves all substantial practices to understand the root cause of each denial and then provide substantial solutions to all denial management. It specifically analyses trends, reworking processes, and all substantial efforts that can help in reducing claim denials.