Audits can be costly and time-consuming if your business is audited by the IRS. Audits are necessary, but that doesn’t mean you will have to go through them alone. It’s no secret that you will face a number of challenges if audited, including high penalties and even potential criminal prosecution in some cases. What you may not realize is that you aren’t obligated to deal with these penalties and other consequences on your own, either. Here is how denial service can assist you.
Denial Management Services Review
The first step in any denial management service is identifying the cause of denial and why it was made. In many cases, this will involve reviewing all relevant records to ensure that everything was handled correctly and that there were no errors made along the way. Once this is completed, it will be easier for the company to determine if there was any wrongdoing or negligence on behalf of their staff or agents. If so, steps will be taken to correct those mistakes so that they do not happen again in future cases.
Analyze Anomalies in Claims Denial
Denial management companies can help with analyzing anomalies in claims denial. This is where the insurance provider reviews patient claims to see if there are any errors or inconsistencies that may be causing denials. If there are any errors, they will be corrected so that future claims do not get denied.
If you have a large number of denials, it can be difficult to go through them all and find out what the problem is. The insurance provider will analyze all of your denials and figure out why they are happening so that they can correct the issues and prevent future ones from occurring.
Analyze Patient Payment Processes
Healthcare organizations need to ensure that their payment processes are compliant with regulations that apply to them. This means understanding the legal requirements for billing, coding, and reimbursement, as well as any specific contractual obligations that may be required by payers — especially when it comes to electronic health records (EHRs). Providers also need to ensure that their policies meet all applicable laws and regulations, including those governing privacy and security. Denial management services are designed to help healthcare organizations meet these challenges in a proactive manner. They analyze all aspects of provider operations related to billing, coding, and reimbursement and identify potential issues or opportunities for improvement based on those findings.
Analyze Financial and Claim Status Reports
An auditor will review your organization’s financial status report to ensure that it matches up with the other documentation submitted with your EHR documentation and certification application. If there is any discrepancy between the two, it could result in a delay or even denial of certification.
After reviewing your financial status report, auditors will typically move on to your claim status report for additional information about claims paid out by insurers for services provided by your organization. Auditors will review this information to ensure that all claims are being paid correctly and within the proper timeframe (usually within 90 days). If any claims are denied by insurance companies because of an issue with documentation or coding, this could also result in delays or denials during certification examinations.
Helping Conduct a Proactive Insurance Eligibility Check
The main step toward avoiding an audit is by conducting a proactive eligibility check. The goal of an eligibility check is to identify potential gaps in coverage before it becomes a problem for either party. This will allow you to fix any issues before they become problems that result in an audit, as well as provide peace of mind for your customers.
Improve Overall Revenue Cycle Performance Through Ongoing Monitoring
Audits are not only used to catch mistakes; they are also used as an opportunity to improve overall revenue cycle performance through ongoing monitoring. Audits that aren’t performed regularly may be missing important details about how well the process is working and what areas need improvement. This allows carriers to make necessary changes before things get worse than they already are.
When facing an audit, an auditor can face a large hurdle. If you are unfamiliar with the audit process and aren’t prepared, it can be a disaster. One of the ways to limit your risk is to partner with an experienced denial management service that can help you avoid denials by understanding and following customer-defined standards.