How Denial Management Software Saves You Time & Money
4 months ago
The rate at which medical claims are denied by insurers is very troubling.
According to a recent survey, the average claim denial rate has climbed by 23% since four years ago.
For medical practices, this involves unpaid services, which result in lost or delayed revenue, severely affecting their financial health.
But before you blame insurers for refusing your claims, take a step back and evaluate your denial management plan.
The majority of denials are caused by incorrect or misleading information in your claims, causing the insurer to disrupt your revenue flow.
The Good News Is
Implementing a solid denial management software might help your organization's claim acceptance rate reach 95% or higher.
Curious to find out more?
This in-depth guide delves deeper into the fundamentals of denial management software, including features, pricing, and development.
- Quickly detect and resolve denials to increase reimbursement.
- Improve your appeals.
- Analytics can help you manage and monitor denials more effectively.
Market Insights
From 2022 to 2027, the US healthcare denial management market is expected to grow at a CAGR of around 8.8%, hitting USD 5.9 billion by that year.
The market for healthcare denial management in the United States is growing due to factors such as increased medical claim denials.
Additionally, complex payer reimbursement systems contribute to this growth.
What Is Denial Management Software & How it Works
Denial management software helps healthcare providers navigate and resolve claim denials from insurers and other payers.
This program discovers, tracks, and, in some situations, appeals claim denials, with the goal of improving revenue cycles and maximizing reimbursement.
These software solutions provide real-time denial tracking, data analytics, configurable workflows, and interaction with existing EHR systems.
As different code systems are employed during the claims process, there are numerous potential errors.
Even one error can lead to a claim being refused.
Denial management software helps you appropriately code your claims and comprehend the meaning of a denial code when a claim is refused.
Benefits of Denial Management Software (DMS)
1. Reduce Burden of Denials
Let's face it, denied claims are a significant financial drain. Studies show healthcare providers can lose upwards of 8% of their annual revenue due to denials.
Now imagine recovering even a portion of that!
With DMS, you gain the tools to identify the root cause of denials, from coding errors to missing information, allowing you to focus your efforts on resubmitting claims efficiently.
2. Save Time & Money
Denial management is a time-consuming process.
Manually sifting through claims, deciphering denial codes, and preparing appeals can overwhelm even the most dedicated staff.
DMS automates many of these tasks.
Imagine intelligent software flagging potential denials before submission, streamlining the appeals process, and even suggesting corrective actions.
This frees up your team to focus on core patient care activities.
3. A Proactive Approach
DMS doesn't just react to denials; it helps prevent them in the first place.
Built-in compliance checks ensure your claims meet payer requirements, while pre-submission scrubbing identifies potential errors before they lead to denials.
This proactive approach streamlines your workflow and improves your first-pass claim acceptance rate
Additionally, reduces the need for rework and appeals altogether.
Custom vs. White-label: Build the Best Denial Management Software for Your Needs
If you’re planning to build denial management software, you have 2 major options,
Both types of software have some pros and cons.
We’re sharing detailed information for your better understanding.
1. Custom Development
Also known as bespoke, refers to creating software, apps, or IT solutions specifically designed to meet the unique requirements and specifications of your organization.
You have to hire a dedicated healthcare IT company for your project.
Custom development involves building a system from scratch, starting with a blank slate.
This technique provides a high level of flexibility and the capacity to address complex or specialized jobs that may not be covered by existing solutions.
Pros
- Design, features, and functionalities tailored exactly to your needs.
- Scale the software seamlessly as your business expands.
- Unique features give you a competitive edge.
- Avoid licensing fees and constant subscription costs.
Cons
- Higher upfront costs
- Longer development timelines
- Need for technical expertise
- Maintenance and updates
2. White-label Software
A white-label software is a pre-built product or service created by a software development business but designed to be rebranded as your own.
Essentially, it allows you to sell a product or service without committing the time, effort, and resources required to create it from the start.
These solutions allow businesses to access new markets or provide more services without incurring significant in-house development costs.
Pros
- Cost-effectiveness
- Time-saving and fast-launch
- Reduced technical expertise requirements
Cons
- Limited customization
- Limited scalability
- Lack of IP ownership
Factors To Consider When Choosing Between White-Label & Custom Development
1. Short-term vs. Long-term objectives
2. Budget and resources
3. Time constraints
4. Branding and identity
5. Scalability and flexibility
If you’re planning to develop denial management software, it’s good to get a consultation from experts like SyS Creations.
We can help you identify your requirements and develop the best solution.
SyS Creations: One-stop Solution for All Your Billing & RCM Software Needs
We’re an Ontario-based healthcare-focused IT company.
We only work on healthcare IT projects.
We have a team of app developers, UI/UX designers, business analysts, compliance specialists, and QA engineers who are well-equipped to build custom platforms and white-label solutions.
Our white-label platform is fully customizable, ready to use and cost-effective.
Here we are sharing our entire 17-step process to build epic solutions for you.
With Our Denial Management Software, You Can
1. Quickly Identify and Resolve Denials
Allows you to group denial code types and categories including soft, hard, clinical, and technical/administrative denials.
Providers also require the ability to specify the hierarchy of denial and reason codes.
By categorizing medical billing denials, your staff can spend more time appealing denials that have a good probability of being overturned, enhancing your collection opportunities.
2. Improve Your Appeals
Staff members can simply check the status of their claims and appeals, document all interactions with the insurance company, patient, or responsible party, and prepare appeal documents.
By giving a denial management solution to your coding staff, you may reduce denial write-offs and increase your bottom line.
3. Spotlight Hidden Denial Trends
Analytics and dashboards let you better understand overall historical denial trends as well as how payers behave in comparison to their peers.
Analytics also provides healthcare providers with a macro-view of all payers combined, as well as an individual payer perspective.
4. Unlock unexpected Results with our AI Solutions
Our artificial intelligence solutions deliver significant insights by employing machine learning and analyzing hundreds of millions of transactions.
They enable you to shift your recovery to a more proactive mode.
Along with a proven level of visibility and control over your recovery process.
Improve Your Business Performance With Our Smart Tools
With the right tool, healthcare organizations like yours can manage denials effectively and increase reimbursements significantly.
For over 10 years, we've been dedicated to developing these tools, pouring our sweat and effort into leveraging our extensive experience.
The best thing about our team members is their healthcare-specific expertise.
Get the winning formula on your side!
Let our team of experts, with their insights and experience, become your trusted partner for success.