In the healthcare revenue cycle, the timely and efficient management of health insurance claim denials is crucial. A claim denial is issued when a payer, such as a health insurance company or Medicare, declines a healthcare provider’s request to be reimbursed for their services. Regardless of the reason, a claim denial can mean a delay or loss in revenue to a hospital, diagnostic center or other provider, restricting cash flow and hampering the provider’s ability to operate efficiently. This makes denial management an important aspect of healthcare administration and a reminder of the importance of accuracy in medical billing and coding.
In this article, we will describe how denial management works, examine the different types of claims denials and look at some of the strategies healthcare providers and their medical billers and coders can use to reduce or prevent them.