denial management

de·ni·al man·age·ment

(dĕ-nī'ăl man'ăj-mĕnt)
A possibly criminal procedure in the U.S. whereby insurers employ subsidiary firms to find reasons to deny payment on legitimate claims.
References in periodicals archive ?
In conjunction, Complete HealthCare Solutions Inc delivers industry-leading RCM services including lowest days in A/R, superb denial management and clean aging, resulting in increased practice revenue.
We will function as your desired operational extension and will cover: Eligibility Verification & authorization, Doctors office follow up, Scheduling and payment posting, Accounts receivable services, Charge Posting, Denial Management, Patient collections follow up and Contact center services.
The RCM services, document management, payer services, provider services, Account Receivables Follow-up, denial management, provider enrolment, medical transcription and Emergency Medicine coding are also few of the essential facilities from our extensive list.
Additionally, internal physician advisers can oversee commercial denial management, coordinate a recovery audit contractor program, and review readmissions, lengths of stay and clinical documentation integrity.
It turns out that most denial management programs have several flaws that, if corrected, can close the gap on those 90% of preventable denials.
Services within the revenue cycle continuum include denial management and appeals, aged insurance accounts receivable management, out-of-state Medicaid credentialing, and system conversion claim inventory recovery.
She provides a data and information strategy assessment tool and discusses gap analysis management, denial management analysis, revenue integrity management, the integration of information roles, redefining workflows, competencies for transforming into a data-driven organization, and defining the role of the chief data officer.
"But it was also around denial management, revenue capture, identification and charge capture, AR management, how quickly it takes a bill to go out, how clean those bills are when they go out the door, and the cost to collect.
His responsibilities include improving clinical performance, overall hospital efficiency, decreasing length of stay and denial management. Lockerman previously served as director of clinical information technology and physician practice integration at Maimonides and is also a gastroenterologist.
The InsightCS[R] software system was developed to run in an all Microsoft[R] environment with a .Net presentation, and includes functionality for Enterprise Scheduling & Registration, Insurance Eligibility Checking (ANSI 270/271), Order Management, Patient Accounting, Billing, Collections, Contract & Denial Management, Document Imaging, Electronic Remittance Advice processing (ANSI 835), Claims Processing (ANSI 837), Medical Necessity Checking with ABN generation, Workflow Process, Dynamic Worklists and Business Intelligence (Data warehousing including KPI's, Business Analytics and Data Cubes).