Denial Management Services| OutsourceRCM

Denial Management Services

Claim denials are not just a reimbursement issue; they point to gaps in eligibility verification, coding precision, and compliance with the payer's guidelines. If unresolved, these issues escalate in the A/R days, burden internal teams, and undermine revenue integrity. Our denial management services extend a proactive approach by providing data analysis to uncover primary issues, optimizing appeals processes, and preventing recurring denials. Restoring operational efficiency alongside improved cash flow enables providers to safeguard profitability while upholding claim lifecycle accuracy. Get in touch today to see how denial intervention can redefine your revenue outcomes with us.

Denial Management Services
We Offer for Seamless Patient Experience

Identifying Denial Patterns

Using CARC/RARC codes to derive sub-codes that isolate specific issues for targeted resolution enables us to capture and classify denied claims systematically.

Root Cause Analysis (RCA)

Our comprehensive analyses uncover the systemic, payer-specific influences or process-centric inefficiencies within the organization.

Denial Work Queue Management

To enhance the pace, we group identical claims under unique queues organized from most urgent to least based on worth and denial type, accelerating processing speed.

Correction of Claims Submission

Our real-time claim editing ensures optimal recovery by amending billing or coding inaccuracies, restating supporting documents as per payer requirements, and resubmitting within cut-off windows.

Appeal Management

We achieve maximum overturn rates on denied claims through robust evidence-sourced appeal packages and detailed payer communications management.

Monitoring Payer Policies

Our denial specialists track changes in payer policies and preauthorization requirements to ensure that avoidable denials do not occur.

Prevention Strategy Implementation

We implement end-to-end denial prevention strategies such as front-end eligibility, fostering enhanced compliance, comprehensive audits, and workflow adhering to outlined protocols.

Reporting and Analytics

Providers can make informed decisions about their revenue cycle through our actionable denial reports alongside performance dashboards.

Predicting Denial Forecasting Trends

We help adjust workflows to mitigate the impact on revenue using intelligence derived from denial data to predict high-risk scenarios.

Provider and Staff Education

Documenting, coding, and submitting claims errors are reduced through targeted training sessions for provider staff for streamlined processes.

Our Benefits-focused Denial Management Solutions

Recovering denied claims is only one part of the picture; caring for your revenue cycle integrity is what maintains your future financial health. Such specialized approaches provide measurable value. Here’s how:

Full Ownership of Denial Lifecycles

Claims are not simply resubmitted; complete denial lifecycle management begins with identification, root cause analysis, appeal execution, and preventive strategy formulation.

Appeals Supported by Clinically Relevant Data

The overturn rate achieved during appeals processing on complex medical necessity denials has significantly improved due to the operations framework led by certified coders and clinical documentation specialists.

Integrated Work Queue Intelligence

The intelligent denial routing system we have in place ensures that high-value, time-sensitive claims are always routed to the most appropriate resolution experts, significantly reducing A/R days for all claims.

Dynamic Payer Policy Monitoring

We guarantee compliance by monitoring your claims against up-to-the-minute changing payer policies and authorization requirements to mitigate avoidable denials.

Predictive Denial Analytics for Preemptive Action

Our analytics engine forecasts burgeoning denial trends, which allows you to adjust workflows and checks well before an impact on revenue occurs.

The ORCM Advantage

Operational Alignment with Your EHR/RCM Systems

With industry-leading EHR and billing systems like Epic, Athenahealth, and Kareo, our partnerships provide unparalleled levels of real-time visibility and workflow alignment collaboration across all stages of denial processing.

Specialized Teams by Denial Type and Payer

Unlike generic service providers, we use nuanced denial and payer-specific strategies to optimize assignment accuracy for resolution teams, enabling faster turnarounds than conversions with more precision.

100% Audit-Ready Documentation Standards

Every appeal and claim correction submission is accompanied by comprehensive compliance documents ensuring protective cover for your practice during audits or federal reviews.

Our In-depth Case Studies That Show Our Commitment to Denial Management in Healthcare

Discover the real-world impact of OutsourceRCM' denial management services through our compelling case studies. We take pride in showcasing the success stories of our satisfied clients who have achieved remarkable results in optimizing revenue and streamlining operations.

Enhancing Claim Approval Rates for a Prominent Family Practice

Streamlining Claims Processing Efficiency to Eliminate Backlogs

Conquering the Insurance Eligibility and Benefits Verification Hurdle

Client Testimonials for Our Exceptional Services

Joan Palmeiri, President,

Healthcare Consulting company

I want to thank you both for the great job you are doing. I could not be happier with my decision to work with you. I am looking forward to our continued relationship and growth.

Kavita Wadhwani,

CEO, CHPPS, CA

OutsourceRCM helped us identify the errors in our billing system that led to delays & losses. Today, we do not worry about internal billing anymore.

Dr. Naras Bhat,

Allergy & Weight Loss Center, PA

They have managed our RCM services with such competency that we have maximized reimbursement year-on-year.

Owner,

Healthcare Management Consultant, TX

The team at OutsourceRCM has reduced the burden on my shoulders and made my life so much easier! They are extremely professional and never seem to skip a beat. I am extremely glad that I found them and recommend everyone to give their services a try.

Private Practice Therapist,

Washington

Your knowledge of billing codes and carrier specific ancillary forms is second to none. I have never had such an experience of claims coming back so much faster. What I like the most is despite having over 200 other clients to attend to, you never fail to deliver first class customer service and results to us.

FAQs

In your opinion, which strategy for denial management leads to the best return on denial recovery?

Our focus is on the most recoverable revenue first. We utilize a payer-specific scoring model with distinct metrics such as denial reason, dollar value, claim age, and historical overturn likelihood pay off decisions in overclaim overturns.

Does your organization resolve disputes at higher levels of care or medical necessity?

Yes, our denial analysts work alongside clinical documentation specialists and construct appeals based on evidence to justify complex clinical denials like DRG downgrades or inpatient medical necessity disputes.

What process do you follow to ensure that integration with existing EHR and billing systems will not disrupt current workflows?

We enable API-based and manual integration with Epic, Athenahealth, Cerner, Kareo, or AdvancedMD, making it possible for our denial resolution workflows to integrate seamlessly into your processes.

How do you guarantee compliance with payer-specific formatting requirements for submission of appeals documents?

We ensure compliance using our denial management platform, which maintains real-time appeal format documents regulated by timelines and templates, ensuring up-to-date compliance across submissions.

How do you identify systemic problems that span multiple departments or specialties with repeat denials?

We perform root cause analysis with denial clustering algorithms to pinpoint where recurring denials stem from: whether they are caused by front-end, mid-cycle, or back-end processes, so we can collaborate with you to refine processes.

Do you support upstream interventions like coding audits and eligibility checks as a method of denial prevention?

Yes—our denial prevention specialists focus on auditing eligibility verification, prior authorization, and coding workflows to seal upstream revenue gaps resulting in reduced first-pass denials.

How is your appeal success rate benchmarked, and do you report by payer and type of denial?

We benchmark appeal overturn rates against national KPIs and provide monthly dashboards detailing performance by payer, denial code, and appeal aging, ensuring transparency for our clients.

Timely filing deadlines are crucial for some payers with shorter appeals timelines; how do you address this?

Each claim is tagged with a specific filing deadline for each payer, and we ensure auto-prioritized claims in our resolution queues, which safeguards high-value claims from being lost due to timing issues.

Will you help me prepare for payer audits by supplying the documentation needed to resolve the denials?

Sure. We capture each appeal, correction, and resubmission along with supporting documents and reasoning that are filed and ready for audit review. These files can easily be compiled for payer or compliance audits.

Are you able to provide denial trend forecasting? How does it aid in reducing future volumes of denial?

Yes. Predictive analytics helps us identify shifts in denial trends, for example, after policy updates or contract renegotiations. This allows workflow changes to be implemented before an upsurge in denials.

Denial Management Services for Efficient Medical Claims Processing