How Claim Denial Management Audits Optimize your Revenue Cycle
                     How Claim Denial 
Management 
Audits Optimize 
your Revenue 
Cycle?
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Introduction
● Most of the providers don’t know about the total number of 
claims denied in the first phase. 
● This is among the primary topics surveyed & discussed, and 
providers are stunned by finding the cumulative percentage of 
revenue lost due to those initial denials. 
● The need for medical documentation and the absence of 
authorizations are the most well-known reasons for claims 
denials Insurance Eligibility Verification services permit to 
check the coverage and benefit details there by reducing the 
denial percentage of the practice.
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● Increasing efficiency and improving billing collection rates 
should be the foremost concern for healthcare providers with 
focus on availing required prior authorizations and eligibility 
verification done before the service is rendered. 
● Claim denials are the refusal of an insurance agency to respect 
a solicitation by a provider/person to pay for healthcare 
services got from the healthcare professionals.  
● The expenses related to not following up on the claim denials 
can affect the businesses and cause inefficiencies within a 
provider’s claims management and revenue cycle.
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● Regular denial management audit helps you to identify the 
claim denials reasons, Such as
○ Duplicate claim submission
○ Service previously adjudicated
○ Services not covered by the payer
○ Time limit for claim submission expired
○ Insufficient medical necessity
● Here a few claim denial reasons are discussed in detail:
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Insufficient Medical Necessity
● This can be a challenging situation for all parties, yet you might 
have the option to avoid them. 
● Regardless of where medical necessity isn’t obvious good 
communication among patients and providers is important to 
make the best decision on medical necessity.  
● At the point when a claim is denied because of medical 
necessity, your practice could be compelled to either assimilate 
the expense of services or endeavor to gather the whole 
payment from the patient neither of which are acceptable 
alternatives.
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Time Limit For Claim 
Submission Expired
● One significant issue medical billers experience is when claims 
are denied for the timely filling because each insurance carrier 
has various rules and regulations for claim resubmission. 
● So it is a difficult task for physicians and billing team to keep up 
with the various timelines with each payor. 
● To avoid this kind of issue outsource your medical billing to the 
best medical billing company that specializes in 
denial management and AR follow-ups.
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● Claims are frequently denied for timely filling even when the 
claim submitted on time however not got by the insurance 
carrier. 
● There are numerous reasons this can occurs, yet the significant 
aspect of the condition is how the biller responds to the denials.
● Other times, claims are denied for timely filing when they were 
not submitted within the filing time frame because of initial 
errors.
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About MGSI
● MGSI is the best choice for medical billing outsourcing in Florida
, US.
 
● We provide various services such as anesthesia billing, 
cardiology billing, insurance eligibility verification services, etc. 
● MGSI enables healthcare organizations and enhances the 
revenue cycle to improve the quality of claims and decrease 
denials rate and claim rejection. 
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Thanks!
Any questions?
You can find us at:
+1 (877) 896-6474
[email protected]
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