Denial Management:
A critical element to a healthy cash flow

RCM Value Added: Outsourcing a Team of Denial Management Services

Denial Management Services is a critical element of RCM because they manage a healthy cash flow. But dealing with this can be time consuming and putting this responsibility to your medical team can take away their attention and focus on delivering excellent patient care.  

A typical US hospital experiences a 9-11% (2020) denial rate but best practice recommendation should be at 4% or less. If a healthcare organization doesn’t have a solid denial management system in place, this could lead to revenue and overall operational loss. This makes denial management service one of the 3 stages of Revenue Cycle Management.

Outsourcing a Team of Denial Management Services

Denial Management Service Subfunctions

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Medical Billing

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Medical Coding

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Claims Checking and Error Resolution

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Claims Submission

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Payment Processing and Posting

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Denial Management

Common Pain Points in Denial Management Service

1. Shortage of Qualified Denial Management Specialists

There is a higher demand for healthcare services, especially denial management experts with the latest coding standards as they are released and updated licenses and certifications. Which makes the hiring pool limited and the cost per hire more expensive.

The influx of new patients and changing medical standards over the years has led to lower productivity among RCM professionals. Unproductive teams in your medical practice will have errors on patients’ records and backed up billing cycles, among other things.

Shortage of Qualified Denial Management Specialists
Expensive Training and Certifications

2. Expensive Training and Certifications

Healthcare is constantly changing. There are consistent updates of medical codes that set changes in insurance payment rules. The highly specialized nature of the denial management field means that your team needs to stay up-to-date on all these changes in order to function at all in business.

This requires new certifications every so often, which is usually very expensive and time-consuming. Such certifications include:

  • ICD-10 Coding
  • CPT & HCPCS Level II Coding
  • Outpatient Coding (COC)
  • Inpatient Coding (CIC)
  • CPC-P Coding
  • CRC Coding
  • AAPC Specialty Medical Coding

Training and providing certifications for in-house teams mean more capital investment and expenses than revenue.

3. Revenue Loss

Revenue loss from claim denials come from many reasons. Without well-managed denial management systems in place insurance claims may be either not processed within the required turnaround time or when insurance companies refuse to process the payment due unfollowed policy regulations from healthcare service or errors (either coding and billing). These denials can be classified as:

  • Soft Denials – temporary but can still be paid if regular follow ups are done
  • Hard Denials – permanent and results to revenue loss
  • Preventable Denials – caused by delay claims processing
  • Clinical Denials caused on the basis of medical necessity or level of care done
  • Technical Denials – either from mistagging of codes or itemized bills

These denials if not corrected will eventually result in revenue loss and will affect the overall financial health of your company.

Revenue Loss

Denial Management Teams

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Medical Biller

Responsible for timely submissions of claims to the insurance companies. They also do constant insurance follow ups to ensure your business is compensated properly, patients are billed correctly, and timely payments are made.
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Medical Coder

Main duty is to assign standard codes using a classification system and analyse clinical statements accurately by using universal codes required by insurance companies.
Documentation of Visits

Claims Specialist

They review insurance coverage, analyse claims cases, and ensure that your company is following legal policies and regulatory insurance procedures.
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Denial Management Specialist

Review and resolve denied insurance claims by reviewing all paperwork the insurance company sends about a claim denial and provide corrective action plans to resolve denials.

Benefits of Outsourcing Denial Management Teams

Building a healthcare team can be daunting especially if there are different kinds of experts in the industry. You need to be aware of the professionals suitable for an RCM system or those that are equipped with the right skills for health informatics. Aside from being aware of interlinking departments, limitations such as talent availability and expensive salary for these experts add another layer of operation challenges.

But with the right outsourcing partner, building a great team of RCM professionals and health informatics experts is one less worry for your business. To fully appreciate how an alliance with the right partner brings great benefits to a company, check the list below:
Building Great, High-performing Teams

1. Building Great, High-performing Teams

The right outsourcing partner will build you a dedicated team of highly-experienced healthcare professionals who can deliver quality results. Building great, high-performing teams usually has 2 components:

These traits are your assurance that they can effectively build a team of highly-experienced professionals who can deliver quality results making your business rise to the top of your competitors and assist in achieving operational stability and excellence.

Substantial Savings

2. Substantial Savings

All companies want to save money and stay within budget. They can help you cut not only salary cost but also operational cost by covering training, license and certifications of your outsourced teams which are usually very expensive and time-consuming.

Outsourcing is the perfect affordable solution because:

  • you can save up to 70% on operational cost
  • work with seasoned professionals

This Cost Savings Calculator can provide a projected overview of potential savings.

Help you achieve business goals

3. Help You Achieve Business Goals

Lastly, outsourcing especially with the right partner will provide holistic support and assistance in your daily operations and help you achieve your business goals. They will keep the denials in check ensuring a healthy revenue cycle. As a result, established collaborative and loyal partnerships will be made while continually they provide you operational excellence in denial management services.

Great Partner, Great Team

Having a competent and skilled team of healthcare professionals is key to quality patient care and in the long run, it can guarantee business’s success.

Infinit-O’s RCM Catalog summarizes how a great partner builds great teams.
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Infinit-O is a trusted global solutions partner that can help you successfully grow your business.

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Curious on how to spot a great team? We’ve got you covered! Know these qualities and traits to help you build a great team!

Cost Comparison per Month:

In-house FTE (full time employee) vs. Infinit-O FTE

Job TitleCost per In-house FTE ($ rate)Cost per Infinit-O FTE
($ rate)
% Savings per Month
Patient Concierge$ 4,300.03$ 1,700.0060%
Data Entry Specialist$ 4,221.18$ 1,600.0062%
Insurance Verification Specialist$ 4,398.59$ 1,600.0064%
*All costs are based on estimated rates and typical fully burdened costs.
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Cost Comparison per Year pie chart GIF

Cost Comparison per Year:

Job TitleNo. of team membersEstimated Annual Cost Savings
Patient Concierge1$ 31,200.38
Data Entry Specialist1$ 31,454.21
Insurance Verification Specialist1$ 33,583.10
*All costs are based on estimated rates and typical fully burdened costs.

For other roles that you wish to add, our Cost Savings Calculator can help you in projecting potential operational cost reductions.

NOTES:

  1. Cost per full-time employees at Infinit-O dedicated to your company. Estimated total cost (fully-burdened) including total personnel costs, all overheads including workstation, software, and rentals. These are all-in costs, there are no hidden fees and we do not charge separate set-up fees.
  2. After further identifying your business requirements we can adjust the plans, match you to the right talent, and build you a great team that fits according to your evolving business needs and goals.

4 Pillars of Success: People, Process, Technology and Security

A well-established People, Process, Technology, Security (PPTS) Pillars is one sure way to overcome the limited supply of workforce, improve the healthcare delivery system, innovate care technologies to ease manual labor and fortify patient data security in agreement with clinician-patient confidentiality.

Having 4 pillars of success are key in only building a great and high-performing RCM team.

Know more about Infinit-O’s 4 pillars of success and our secret in building a great, high-performing RCM team.

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Success Stories

To successfully grow your business and achieve your goals, it starts with proper planning and investing in the right resources. The following companies in the HC industry were able to identify their unique needs and sought help with the right partner who exactly knows how to address their demands. 

We’ve gathered the following success stories so you can learn more about their outsourcing journey and how they were able to achieve their business objectives with the help of the right partner.

Infinit-O has been in the outsourcing industry for 15 years, creating long lasting partnerships and endless opportunities to small and medium businesses across the Healthcare, Finance and Accounting, Research and Development, and Customer Service industries.

Our vision is to help small and medium sized companies to grow and prosper by enabling them to experience the full benefits of partnering with an outsourcing company.

We build great teams for our partners through understanding their unique needs in order to help them achieve their business goals and the vision they have for their company.  We have rendered a strong combination of business consultancy, process optimization, and outsourced services; all utilizing the latest technology to provide excellent value for our clients.

Get to know us more through these channels:

Infinit-O Information Security

We share 15 years of experience in navigating data privacy laws and regulations. We guarantee strict compliance from the best information security practices with up to date cybersecurity certifications because your data is in our care. At Infinit-O, we not only value your business but acknowledge the importance of information security especially in this digital age. To overcome customary challenges and build a better cybersecurity system that ultimately protects and secures data, we are certified and compliant with:

Learn more about the full list of our Information Security bundle in this Whitepaper.

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Infinit-O Key Benefits

Having an extensive and profound expertise in the finance and accounting industry, we’re here to help you build a great RCM team for your unique needs and promise the following key benefits:

Ready to explore infinite opportunities to grow?

Let’s begin your growth success story.

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