What is Medical Claim Denial Management?

Of Healthcare Claims [What it is – How it works]

Dr. David Edward Marcinko MBA

[Editor-in-Chief]

NEU Dr. MarcinkoTypically, denied and rejected healthcare claims quickly surface as a source of multi-millions in revenue leakage and unnecessary expense for doctors, clinics and hospitals, etc.

Why?

Payers have been struggling with increased costs.  They thoroughly inspect claims for errors and have become adept at using their rules to deny and delay claims.

For example, Zimmerman reported the denied percentage of gross charges climbed from 4% in 2000 to 11% in 2011.  In contrast, providers typically lack the tools to aggressively manage current denied claims and prevent future ones.

Financial Recognition

Without denial tracking, an organization may not recognize the heavy financial impact of denied claims.

A HARA [Hospital Accounts Receivable Analysis] report indicates that bad debt and gross days are declining. However, a majority of providers write off denials as contractual allowance, distorting the numbers but not the resulting lower margins and reduced cash.

H*Works reported that the typical 350-bed hospital loses between $4 million and $9 million each year in earned revenue from denials and underpayments (assume $103 million annual gross revenue and 40% contractual allowance). Recouping lost revenue from denials and underpayments will, according to H*Works, increase an organization’s operating margin by 2.6%.

Industry estimates report that at least 50% of denials are recoverable and 90% are preventable with the appropriate workflow processes, management commitment, strong change leadership, and the correct technology. H*Works estimates that for a revenue capture of $3 million from denials and underpayments, the recovery infrastructure costs are only about 3%.

Product DetailsProduct Details

Assessment

With all this in mind, better management of rejections and denials, as well as the information necessary to resolve and prevent them, surfaces as probably the best strategy to improving financials. By streamlining the revenue cycle, managing rejections and denials proves to be less expensive and to provide faster returns than initiating new services.

Conclusion

Your thoughts and comments on this ME-P are appreciated. Feel free to review our top-left column, and top-right sidebar materials, links, URLs and related websites, too. Then, subscribe to the ME-P. It is fast, free and secure.

Speaker: If you need a moderator or speaker for an upcoming event, Dr. David E. Marcinko; MBA – Publisher-in-Chief of the Medical Executive-Post – is available for seminar or speaking engagements. Contact: MarcinkoAdvisors@msn.com

OUR OTHER PRINT BOOKS AND RELATED INFORMATION SOURCES:


Product DetailsProduct DetailsProduct Details

SUNK COSTS: The Fallacy

By Staff Reporters

***

***

A common term in business, the sunk cost fallacy applies to our choices and activities made daily.

CITE: https://www.r2library.com/Resource/Title/082610254

A sunk cost fallacy is a simple logical fallacy that means sticking with a losing or failed venture or activity because you have already invested considerable time, energy, money, or other things you can’t get back. It’s the idea that because you already have incurred costs, you stick with it to  “get your money’s worth.”

The sunk cost fallacy differs from other logical fallacies because it’s not a rhetorical fallacy. You may also experience a discussion with a “red herring” or “straw man” fallacy with someone. But the sunk cost fallacy is an illogical choice as a way to justify to yourself why you keep doing something.

***
COMMENTS APPRECIATED

Thank You

***

***

About Pandemic Cyber Monday 2022

How to Do it Like a Pro

Need help getting the best online deals on Cyber Monday? You may with these shopping tips for our ME-P readers and subscribers, and you’ll be ready for the biggest traditional online shopping day of the year.

Best of all, you can learn a few fun facts along the way!

OMICRON: https://www.msn.com/en-us/money/other/urgent-push-to-gauge-omicron-threat-on-claim-symptoms-mild/ar-AARe4nj?li=BBnb7Kz

DELTA: https://www.yalemedicine.org/news/5-things-to-know-delta-variant-covid

Assessment

When you’ve learned everything you need to know, be sure to bookmark this Cyber Monday page and come back next year to again save on the best holiday gifts in 2023.

Channel Surfing the ME-P

Have you visited our other topic channels? Established to facilitate idea exchange and link our community together, the value of these topics is dependent upon your input. Please take a minute to visit. And, to prevent that annoying spam, we ask that you register. It is fast, free and secure.

Conclusion

Your thoughts and comments on this ME-P are appreciated. Feel free to review our top-left column, and top-right sidebar materials, links, URLs and related websites, too. Then, subscribe to the ME-P. It is fast, free and secure.

Speaker: If you need a moderator or speaker for an upcoming event, Dr. David E. Marcinko; MBA – Publisher-in-Chief of the Medical Executive-Post – is available for seminar or speaking engagements. Contact: MarcinkoAdvisors@msn.com

OUR OTHER PRINT BOOKS AND RELATED INFORMATION SOURCES:

Product DetailsProduct DetailsProduct Details

Product Details  Product Details

   Product Details

What is “COMPASSION FADE?”

A Cognitive Bias of the Corona Virus PandemicCourtesy: www.CertifiedMedicalPLanner.org

By Dr. David E. Marcinko MBA

Compassion Fade is a cognitive bias that predisposes people to behave more compassionately towards a small number of identifiable victims than to a large number of anonymous ones.

LINK: https://www.amazon.com/Dictionary-Health-Insurance-Managed-Care/dp/0826149944/ref=sr_1_4?ie=UTF8&s=books&qid=1275315485&sr=1-4

It is the psychological explanation to the known phenomenon alluded to by Joseph Stalin in his famous quote “The death of one man is a tragedy; the death of millions is a statistic”.

***

2

***

LINK: https://www.publichealthpost.org/research/compassion-fade/

Assessment: Your thoughts and comments are appreciated.

***

BUSINESS, FINANCE, INVESTING AND INSURANCE TEXTS FOR DOCTORS:

THANK YOU

Product DetailsProduct DetailsProduct Details

***

DAILY UPDATE: Greenish on Black-Friday

By Staff Reporters

***

***

Online shoppers didn’t let concerns about higher prices or a recession keep them from a record-setting this Black Friday.

Consumers spent a record $9.12 billion while online shopping Friday, according to Adobe Analytics, which tracks more than 85% of the top 100 U.S. online retailers. That’s an increase of 2.3% over a year ago – surpassing the previous online Black Friday sales high mark of $9.03 billion in 2020. Nearly half (48%) of online sales were made over smartphones, up from 44% last year, according to the company’s 2022 Holiday Shopping Trends & Insights Report.

***

COMMENTS APPRECIATED

Thank You

***

ORDER: https://www.routledge.com/Comprehensive-Financial-Planning-Strategies-for-Doctors-and-Advisors-Best/Marcinko-Hetico/p/book/9781482240283

***

PODCAST: What is Public Health?

By American Journal of Public Health

***

Public health is now part of the political conversation but everyone doesn’t understand it in the same way. Hence the idea of interviewing Governor John Kasich, former governor of Ohio, who has been promoting a greater attention to public health, about what is public health for him.

CITE: https://www.r2library.com/Resource/Title/082610254

***

***

COMMENTS APPRECIATED

Thank You

***

***

INSURANCE: https://www.amazon.com/Dictionary-Health-Insurance-Managed-Care/dp/0826149944/ref=sr_1_4?ie=UTF8&s=books&qid=1275315485&sr=1-4

***

TECH: https://www.amazon.com/Dictionary-Health-Information-Technology-Security/dp/0826149952/ref=sr_1_5?ie=UTF8&s=books&qid=1254413315&sr=1-5

***

%d bloggers like this: