Managing Denials

January 1, 2008

I am looking for software that will nearly eliminate our claim denials. I started my practice four months ago and my collection ratio is only 10 percent. We have had a tremendous amount of denials, many of which have been simple office mistakes.

Question: I am looking for software that will nearly eliminate our claim denials. I started my practice four months ago and my collection ratio is only 10 percent. We have had a tremendous amount of denials, many of which have been simple office mistakes.

Answer: What billing software or management software do you use now? Make sure you are first optimizing what you have.

You also might look through some denials and chart what is causing the majority of them. Is it a need for checking patient eligibility? Poor demographic data? Poor coding? That will help you determine what problem you really need to solve.

Software alone won’t solve staff errors. It’s the old “poor data in = poor data out” problem. But revenue cycle management software will really help with coding and all the payer rules and they even help with appeals. Other systems might help more with eligibility.