DENIALS MANAGEMENT

WE TRACK, MANAGE TRENDS AND REDUCE THE TORRENT OF CLAIM DENIALS.

INCREASE REVENUE BY 20% OR MORE, SPEED UP YOUR CASH FLOW.

Denials can have an adverse effect on your cash-flow. Managing denials promptly and effectively will result in an increase in the cash flow and enhance the effectiveness of the billing process with higher first-level passes. QWay’s Denial Management Program addresses both historical and future claims with the ability to recover otherwise lost revenue.

Denials occur due to reasons like:

  • Inaccurate or Incomplete Insurance information
  • No Pre-Authorization Code
  • Errors and Omissions related to coding and charges
  • Filing claims past the stipulated time
  • Credentialing Errors or no enrollment of the provider.

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The Denial Management process at Qway is carried out with data and trend analysis – the key to the success of the process. Our systematic way of tracking denials gets information back to the billing process to prevent future denials of the same nature.

We drive up your cash flow and reduce the flood of denials by:

  • Analyzing the volume of the denials and baseline analysis
  • Evaluating denials with respect to age, claim expiration, non-meeting of deadlines
  • Statistically estimating the denials based on payers, providers, CPT codes and general non-compliance to the ICD 10 standards.

frequently asked questions

  • What is Denial Management?

    Denial management is a critical step in the Revenue Cycle Management. A denial is the ability of the Insurance payer to refuse the payment of a claim for the services rendered to a patient by the Healthcare Provider. A Clinical denial however is based on Coding reacted issues, Medical Necessity, Length of stay and or the level of Care, including other clinically related determinants.

  • What is the industry standard?

    Working on getting these denials paid are a tedious and lengthy process. The clinical denials require an appeal by the Healthcare organization. According to research the average cost to rework a claim is $25. Denial rate of a 5% to 10 % is the Industrial average. Maintaining this standard below 5% would be the end goal resulting in the organization maximising its revenue.

  • Preventive measures instead of reactive measures

    Calculate your denial rate- (Total $ of claims / Total $ of claims denied) Educate your staff members with regular training and webinars Identify the pain points and implement repeatable processes Evaluate the success rate of your organization by applying a set standard of Key performance indicators

  • How does QWay fit into this process?

    Clinical denials result in a major impact on the growth and financial turnover of a Healthcare Organization. When managing staff training and frequent changes in payer requirements appear to be a challenge. Denials are not the death of a Practice, taking control and eradicating denials increasing revenue would be the end goal. Finding a partner (Co-Sourcing), who upholds the values of your business just the same would be a good start.

COMPLIANCE / AFFILIATIONS

We Respect Rules & Regulations

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HIPAA

Compliance to HIPAA regulation

HBMA
HEALTHCARE BILLING

Robust quality system with stringent controls at highest standards of data security.

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ISO 9001:2015

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