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.
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.
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:
Training and providing certifications for in-house teams mean more capital investment and expenses than revenue.
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:
These denials if not corrected will eventually result in revenue loss and will affect the overall financial health of your company.
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.
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:
This Cost Savings Calculator can provide a projected overview of potential savings.
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.
Infinit-O is a trusted global solutions partner that can help you successfully grow your business.
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!
| Job Title | Cost per In-house FTE ($ rate) | Cost per Infinit-O FTE ($ rate) | % Savings per Month |
| Medical Biller | $ 4,626.69 | $ 1,600.00 | 65% |
| Claims Specialist | $ 4,480.26 | $ 1,700.00 | 64% |
| Medical Coder | $ 5,277.18 | $ 2,400.00 | 55% |
| Job Title | No. of team members | Estimated Annual Cost Savings |
| Medical Biller | 1 | $ 36,320.26 |
| Claims Specialist | 1 | $ 33,583.10 |
| Medical Coder | 1 | $ 34,526.21 |
NOTES:
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.
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:
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.
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:
