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Denial Management

Denial Management Minimize lost reimbursements and denials with highly efficient systems and services designed to meet your needs. Maximize your effectiveness at collecting unpaid claims. Mediscope expertly tracks and manages timely follow up on all unpaid claims, ensuring that no time is lost on pursuing every reimbursement possibility.

  • AR Analysis
  • insurance-follow-up
  • Self pay follow- up
  • Our proven cash flow and revenue management services will improve operational cash flow by reducing bad debit and write-offs.
  • We manage customer revenue risk while at the same time improving customer relationships.

Do you know what statistics say :

  • Medical practices are failing to collect 25% of the money they’re owed
  • $125 billion is left on the table every year in unpaid claims
  • Only 70% of claims are paid the first time they’re submitted. 30% are either denied (20%) or lost or ignored (10%).
  • Of those claims, 60% are never resubmitted to payers.
  • Medical practices never collect on a full 18% of claims.

Below is the some of the preventable denials :

  • Registration inaccuracies
  • Ineligible for insurance
  • Diagnosis code not valid
  • Charge “Bundling”
  • Incorrect Modifiers
  • Timeliness
  • Expired Credentialing or Provider Enrollment
  • Medical necessity
  • No Authorization or Referral NAthi

Some of the unavidable denials, due analysis per carrier wise would reduce such kind of denials :

  • Medical Necessity
  • Additional information requested

Unless there are extenuating circumstances, less than 7% claims should be denied on original submission. 90% of denials are preventable 67% are recoverable.

Mediscope takes care of all the critical functions involved in AR management including filing of appeals, assessing insurance low pays, updating insurance contracts, managing unapplied balances, managing refunds, and processing patient statements and delinquency letters.

Mediscope’s team of experts is always available to offer immediate support to you and your staff no matter what the issue or problem may be,

  • Identify, manage, and track all of your denied claims in one system
  • Ensure that every denied claim is assigned to your appropriate staff
  • Automate repetitive tasks to boost efficiency and productivity
  • Gain an in-depth analysis of denied claims with integrated reporting

Accounts Receivable Analysis

One of the easiest methods for analyzing company’s accounts receivable is to print an AR report, which is a standard report in any accounting software package. This report divides the age of the accounts receivable into various buckets, which you can sometimes alter within the accounting software to match your billing terms. The most common time buckets are from 0-30 days old, 31-60 days old, 61-90 days old, and older than 90 days. Any invoices falling into the time buckets representing periods greater than 30 days are cause for an increasing sense of alarm, especially if they drop into the oldest time bucket.

Claim wise denial review , analyzing the denial pattern would identify percentage of inaccuracy in claim submission will be identified. Immediate action on these areas, which are preventabe would enhance the practice status.

Analysis results were shared to the operational team / alerting the team would prevent the denials in a practice.

Insurance Follow-Up

MEDISCOPE Insurance Follow-Up Department is staffed with seasoned insurance specialists who have extensive experience with healthcare claims. Our team coordinates efforts with all required parties to ensure appropriate information is provided to the insurance carriers in a timely and accurate method. All claim payments received are verified against expected reimbursement to capture under payments and identify appeal opportunities. MEDISCOPE’ Insurance Follow-Up Department appeals denied and underpaid claims on your patients’ behalf to ensure covered services are paid according to the patients’ benefit plans.

Our staff is trained in billing operations for both Physicians and Hospitals and is highly capable of following up on insurance, determining why the claim may not have been paid or was denied originally and correcting the claim to make sure it gets paid. We have the necessary ability and persistence to resolve most insurance issues.