Denial Management
Services for Healthcare Providers
Stop managing denials. Start preventing them with our AI-powered denial management services in Virginia. Let us handle your revenue cycle for more revenue collection, fewer headaches and better focus on patients.
About Our Insurance Denial
Management Experts
Virginia medical billing is an award winning, certified company offering cutting-edge RCM services to providers based in Virginia and across the US. For the last 10+ years we have been serving all medical practices and lowering their denials by more than 70%. Our denial management services are tailored for your practice’s weaknesses, employing custom solutions to tackle revenue leakages.
Medical billing experts of our company help Virginia-based providers in lowering the ratios of claims denials by thoroughly investigating them, applying immediate edits and strengthening the preventive measures. We deal with your revenue cycle, helping medical professionals focused on patient care and free from lengthy appeal and paperwork headaches.
What Are Denial
Management Services?
Denial management is a critical step in medical billing involving various steps like identifying reasons of claim denial, internal and external factors/mistakes, rectifying or correcting mistakes, resubmitting claim, and filing appeal to payers for reimbursement in case of hard denial.
Timely identification of claim denial allows providers to appropriately react to such incidences and resolve these issues to reduce leakages to their revenue stream. Outsourcing insurance claim denial management from a professional company like Virginia medical billing helps providers to stay focused on their core job, patient care without devoting much of their time and efforts to resolving denials. With our assistance, providers may resolve up to 50% of hard denials within weeks.
Our Denial Management Services
Denial Prevention and Pre-Claim Scrubbing
Our denial management team is trained and skilled at preventing all claim denials for healthcare providers in Virginia. Our company’s locally developed time-tested methods like pre-claim scrubbing help the billing team in achieving a high clean claim submission rate of 99%.
Denial Tracking and Root Cause Analysis
Virginia’s medical billing team delves deep for finding root cause of claim denials, making necessary edits and applying preventive measures for future recurrences. Each denial is tracked thoroughly with useful and practical steps so you may receive full reimbursement. p>
Denial Resolution and Re-Submission
Our proactive denial resolution team is vigilant and stays updated with changing payer policies helping your practice in meeting payer reimbursement policies and industry standards. In case your claim is denied, we resubmit the claim after making appropriate changes.
Expert Appeal Management
We effectively manage the appeal process for handling hard denials with clinical justification and extensive payer negotiation. After a claim is denied by insurers, our medical billing team edits the claim, submitting it within 24 hours without wasting time.
Underpayment Recovery
Our certified medical billing team in Virginia takes care of not just denied claims, but also underpayments. Transparent reporting allows our RCM experts to recover underpayments owed by payers and patients via text, call, mail and email for recovering past dues.
Reporting and Analytics
Beside managing your practice’s insurance denials, we provide data-driven insights, trend identification and remedial actions to employ for stopping denied claims permanently. We help providers understand their healthcare organization’s financial health and resolve any issues causing revenue leakage before they become deep.
Why Denial Management Matters
for Your Practice
Impact of Claim Denials on Cash Flow
Claim denials have a huge and devastating financial impact on a medical practice’s revenue stream. More than 50% of denied claims become lost revenue if not managed properly by a professional team.
Read More
Common Reasons Claims Get Denied
Most common reasons for a claim denial include coding errors, eligibility issues, ignoring prior authorization, missing documentation, etc. Additionally, it may also involve Medicare/Medicaid local rules, and medical necessity disputes.
Read More
Benefits of Denial Management
Reliable denial management by a professional team ensures higher recovery, compliance, and reduced AR days. Moreover, regular audits, secure and accurate documentation, compliance with coding standards helps in identifying denial patterns.
Read More
Insurance Claim Denial
Management Services Tailored to You
Focus on personalized
solutions for different healthcare practices- Coverage across
hospitals, physician practices, specialty clinics
- Scalability for high/low
claim volumes and resolution
- Easy integration with
existing EHRs and billing systems
- Expert dedicated team
for managing specialty-specific denials
- 100% compliance with
Medicare, Medicaid, and commercial payer rules
- Denial management tools
developed on latest ICD-10/ICD-11, CPT, HCPCS codes
How Our Denial Management
Process Works
- Step 1: Claim analysis
and categorization
- Step 2: Root cause
identification
- Step 3: Corrective
action + re-submission
- Step 4: Appeals filing
with strong documentation
- Step 5:Reporting &
feedback loop to prevent future denials
Benefits of Outsourcing Medical
Denial Management Services
Faster Payments & Higher Clean Claims Rate
By outsourcing Virginia medical billing company, providers get 30-50% faster payments with 99% clean claim rate achieved through efficiency and expertise.
Cost Savings vs. In-House Staff
Outsourced medical billing services in Virginia offer 50-70% operational cost savings in comparison with in-house billing and denial management.
Compliance & Regulation Expertise
We help new clinics and group practices in improving compliance with HIPAA, state, local and federal healthcare regulations.
Scalable Support
Our medical insurance claim denial handling offers flexibility and scalability as per your practice’s requirement in effectively managing and prevention of denials.
Improved Patient Experience
With a skilled team like Vriginia’s RCM experts, improving patient experience becomes easy with timely reimbursements and fewer billing surprises.
Why Choose Virginia Billing
for Denial Management?
- 90%+ decrease in denials
- 82% improvement in
productivity
- 65% reduction in
operational costs
- 50% reduction in aging
A/R
- 99% achieve net
collections
- 10+ years of experience
- Trusted by 500+
providers
- Top ranking customer
services
Frequently Asked Questions (FAQs)
Denial management solutions is a critical part of revenue cycle management where a team of experts focus on identifying, addressing, and resolving denied claims from insurance payers. Without effective handling of denied claims a provider’s hard earned revenue may be lost and added as bad debt.
There are many reasons where a claim is denied and payers refuse to pay the amount of reimbursement to providers. Common reasons may include incorrect / invalid or outdated coding, missing patient information or misspelled patient or provider name, failure to meet payer guidelines, lack of medical necessity, failure to obtain prior authorization or invalid insurance eligibility and expiration of health plan among many issues that may contribute to a claim denial by payers.
A proactive and effective denial management service helps healthcare professionals finding the root causes of claim denials, internal and external factors both. It also helps you in addressing the problems, gaps and in-house team’s billing practices like use of outdated medical codes, frequently missing claim submission deadlines, ignoring documentation protocols, etc. By improving these sections, a medical practice may reduce denials over time up to 70% or more and increase revenue easily.
At Virginia medical billing company, we follow industry’s established standards like collecting all the data about denied claims and analyzing them with a microscopic view and finding the reasons leading to such outcomes. Our denial management specialists correct errors, report ten findings to the medical billing team and resubmit the claim to insurers for reconsideration.
There’s no fixed time to resolve a claim denial, it all depends on the errors and their complexity level that may take more time in resolving it. Rejections are resolved within 24-hours whereas, hard denials may take up to 4 weeks or more, depending on the payer policies. Our team has complete knowledge on all commercial, state and federal health plans and reimbursement policies which help your practice to see quick resolution of these issues.
Yes our medical billing company offers a full RCM suite including handling claim denials and filing appeals to recover reimbursement on rendered services. Our denial management solutions include obtaining detailed explanations and supporting documentation to justify medical necessity and why treatment was provided to improve patient’s quality of life and it should be approved without further delay.
Dedicated denial management services offer numerous benefits to healthcare practitioners like lowering their practice’s claim denials, improving coding and billing accuracy, plugging the revenue leakages, reducing AR days, speeding up the reimbursement process and finally ensuring clean claims are submitted only. The above mentioned steps lead to better financial health of your healthcare organization by strengthening bottomline for improved cash flow.