Claim Denial and appeal management services with MedsIT Nexus

Why would you not partner with MedsIT Nexus when its impeccable soft and hard denial management and appeal services are among the top-rated in the healthcare industry, contributing to a decrease in the claim rejection ratio through experts? It is time to recover your lost revenue and reach the glory of success. Let's get to know how we are a top recommendation for you.

MedsIT Nexus 360° Denial and appeal management process and services

Our denials management process in medical billing assists medical facilities in ensuring our medical providers are appropriately compensated for medical services, procedures, equipment, treatment, and care. Our comprehensive process entails:

Step 1. Pre-emptive measures

• Front-end verification at the point of service
• Pre-authorization
• Education and training on the latest guidelines
• Education and training on the latest guidelines Use of a checklist of do’s and don’ts to escape errors

Step 2. Denial identification, tracking, and analysis

Identifying why your patient's claim was denied is fundamental to streamlining the process to maximize revenue collections and escape further claims rejections. Therefore, we entail:

Tracking denials to find patterns and recurring issues	Claim adjustment reason codes (CARC) analyzing
Interpreting the payer’s feedback	Examining the main reason for the denial
Conducting periodic auditing of claim	regularly check the payer’s explanation of benefits (EOB) and electronic remittance advice (ERA)

Step 3. Categorize denials

Categorizing of denials based on reason such as:

• coding errors
• lack of medical necessity
• duplicate claims
• issues with patient eligibility
• Exceed time limit
• wrong patient identifier information
• wrong, insufficient, or nonexistent documentation
• out-of-network care

We also categorize denials depending on the type, such as:

• soft denials
• Hard denials
• Administrative denials
• Clinical denials
• Preventable denial

After this categorization, we assign our experts to investigate the issue in-depth and implement different strategies to resolve it.

Step 4. Timely Claim resubmission

This comprehensive step involves:

• providing additional documentation
• verifying patient eligibility
• compliant claims submission
• Attaching an updated copy of the claim along with a copy of the original claim
• Attaching a copy of the remittance advice
• Double-checking the payer's EOB to ensure the correctness
• Proactive follow-up
• Addressing denials timely
• Maintaining all records of actions and protocols taken to resolve denial
• Utilizing automated systems and software solutions for claim follow-up

Step 5. Appealing when necessary

• Call the payer for clarification on the denial of a claim
• Request an unbiased and detailed review of a claim
• Use standard and customized appeal letters by individual payers
• Mention CPT/CMS or payer's guidelines on appeal letter
• Attach only the necessary/applicable documentation related to the claims process
• supervise and manage the appeals process through our professional reviewer

Step 6. Prevention of further denials

We use upgraded systems, conduct targeted trend probes, and identify payor trends to prevent further issues.

Merits of outsourcing denial management and appeal system with MedsIT Nexus

Updated with the latest coding & billing guidelines

Claim denial management and appeal cannot succeed without constantly adapting to the newest coding or billing guidelines, payer policies, government regulations, and other updates. MedsIT Nexus, the leading billing company in the USA, never compromises on staying updated on any change.

KPIs Insights for Better Decision-Making

Consistent monitoring of the effectiveness of denial management is the cornerstone of keeping track of progress. Therefore, we keep insights into different metrics like

• denial rates
• denial turnaround times
• appeals success rate by case types and payers

Regular and customized reporting

Detailed and regular reporting, suggestions, and recommendations for:

• resolution rates
• overturning with payer-specific resubmittal tips
• claim appeal values for roll up to Finance and Revenue Integrity

It fosters open communication, transparency, and trust relationships with our clients.

Clearinghouse assistance

From assisting insurance companies to providing proof and explanations, MedsIT Nexus establishes a solid relationship with the clearinghouse to improve the process and benefit both groups.

Why do you prefer MedsIT to handle claim denial management services?

MedsIT Nexus understands that a high denied-claims rate hurts a physician practice’s financial bottom line. Our effective denials management significantly improves the healthcare practice’s financial health and patient satisfaction.

Expertise

With more than ten years of industry experience, denials management specialists discover and analyze denied claims, work to overturn denials and implement effective strategies to prevent future denials. Moreover, our appeals specialists form and submit appeals for denied claims.

Skilled team

MedsIT Nexus team who is managing denials and appeals possess a specific set of skills, including:

• Understanding of HCPCS Level II, ICD-10-CM, and CPT codes
• Understanding of insurance policies
• Analytical skills to analyze denial patterns
• Strong written and verbal communication skills
• attention to detail
• The ability to solve problems and find solutions
• Knowledge of the revenue cycle

Compliance support program

Our revenue cycle analysts use a gold-standard compliance program that coheres with OIG's requirements. By conducting compliance auditing, MedsIT Nexus stays HIPAA-compliant to protect patient health information (PHI).

Upgraded technologies and systems for editing & optimization

Embrace the efficiency of your RCM solution with our automated, upgraded, and optimized system to reduce manual tasks and increase productivity.

• Claim management software
• Automated denial workflows
• Analytics systems
• Claim scrubber

These solutions perform procedure code edits, medical necessity edits, diagnosis code edits, outpatient prospective payment system (OPPS) edits, claim-level technical edits, and file format edits.
However, the one-size-fits-all approach does not work well in catering to each client's need for a claim denial solution. Therefore, we thoroughly analyze what client needs and what sort of technology, hence maximizing results within existing workflows.

Easily accessible

We are proudly handling both types of denials, either hard denial or soft denials, all across the United States, particularly in

Specialties and markets we serve

Through our experience, we have cracked the code on appealing preventable denials and securing reimbursement for thousands of preventable cases across more than 90 specialties in the USA.
No matter the size, we professionally deal with each claim resolution for all types of practices, including

• hospitals
• Private clinics
• Freestanding facilities
• Physician practices and medical groups
• Small, medium, and large practices

What sets us apart?

• End-to-end strategies for managing denials
• Understanding of claim formats
• Specialty-specific services, not one-size-fits-all
• 24/7 support systems
• Corrective action recommendations tailored to the needs
• Increased clean claim rate (CCR)
• Collaborate with payers
• Quality over quantity
• proficiency in commercial, state, and federal payer policies
• Increase reimbursement by up to 30%

Ready To Collaborate With Our Denial and Appeal Management Experts?

Don't let denials hold you back; schedule a consultation now to explore more about our tailored services, how we lead denial, and the appealing process to decrease claim denial. Get started now and feel the positive impact our services can have on your revenue and reputation. Our customer representatives are always there to help and clear up your confusion.