{"id":366,"date":"2011-05-25T14:45:10","date_gmt":"2011-05-25T18:45:10","guid":{"rendered":"http:\/\/www.poweryourpractice.com\/?p=366"},"modified":"2011-05-25T14:45:10","modified_gmt":"2011-05-25T18:45:10","slug":"denial-management-how-to-improve-the-process","status":"publish","type":"post","link":"https:\/\/carecloud.com\/continuum\/denial-management-how-to-improve-the-process\/","title":{"rendered":"Denial Management: How to Improve the Process"},"content":{"rendered":"<p>For physician practices and medical billers, there\u2019s nothing more frustrating than a <strong>denied claim<\/strong>. The work was done but, through some technicality or minor coding error, the payer refuses to pay.<\/p>\n<p>Practices must <strong>resubmit their claims<\/strong> with the hope that they corrected the problem and can now get the money they are owed. Even if the practice can collect, they\u2019ve already lost a significant chunk of the money they deserve.<\/p>\n<p><!--more--><\/p>\n<p><strong>It costs $25 to $30 to manage the average denial<\/strong>, according to the Medical Group Management Association (MGMA). The best thing practices can do for their bottom line is to <strong>improve denial management<\/strong> and submit cleaner claims from the start.<\/p>\n<p><strong>Cleaner Claims<\/strong><br \/>\nManual denial management is a daunting task. Sifting through <a href=\"https:\/\/www.carecloud.com\/continuum\/physicians-prepare-for-surprising-cost-of-icd-10\/\" target=\"_blank\" rel=\"noopener\">thousands of codes<\/a> and recognizing what is being denied by which payer is a costly and time-consuming venture. The most efficient way to handle it is through <strong>denial management software <\/strong>systems.<\/p>\n<p>\u201cThe goal for every practice or medical biller is to get their claim paid on the first pass,\u201d says CareCloud\u2019s Director of Operations Francis Guasp, CPC. \u201cWith how far billing software has advanced, practices can implement web-based denial management systems quickly and cost effectively to see improvement in first pass resolution rate almost immediately.\u201d<\/p>\n<p>Instead of working harder to collect less money, practices can utilize new technologies to get paid more while reducing labor costs. Francis recommends taking an in-depth look at your practice\u2019s revenue and denial rates to determine what type of system could provide the most benefit to your business.<\/p>\n<p>\u201cPractices can get a stand-alone denial management system and bolt it on to their practice management systems, but I would suggest finding a system that is fully <a href=\"https:\/\/www.carecloud.com\/continuum\/how-to-choose-practice-management-system\/\" target=\"_blank\" rel=\"noopener\">integrated with practice management<\/a>, medical billing, scheduling and so on. It will streamline revenue cycle management and make things much easier,\u201d explains Francis.<\/p>\n<p><strong>A Denial Management System Should Include:<\/strong><\/p>\n<p><strong>Charge Entry Analysis<\/strong> \u2013 Check claims in real time to verify diagnosis and procedure codes as you type to ensure compliance before submittal.<\/p>\n<p><strong>Sophisticated Rules Engine<\/strong> \u2013 Track payer denial activity and identify new rules. Web-based systems can anonymously track these rules over the user base and automatically distribute new rules over the entire network for complete claims qualifications.<\/p>\n<p><strong>Claim Alerts<\/strong> \u2013 Automatic responses for events like claim resubmissions and claim status to enhance payment transparency and ensure that money doesn\u2019t fall through the cracks.<\/p>\n<p><strong>In-Depth Analytics<\/strong> \u2013 Customizable real-time reporting to make sure claims are being paid in full and spot areas where improvements can be made.<\/p>\n<p><strong>Functionality and Flexibility<\/strong> \u2013 The ability to integrate with other software systems and be easily upgraded for changes in rules and coding.<\/p>\n<p>A recent study conducted by Project HOPE, The People-to-People Health Foundation, Inc., found that it costs physician practices an average of $68,274 per physician per year to interact with patient health plans. Wouldn\u2019t it be nice to get some of that time and money back?<\/p>\n<p><strong>Tell us how you handle tricky payers and denial management by posting a comment below.<\/strong><\/p>\n","protected":false},"excerpt":{"rendered":"<p>For physician practices and medical billers, there\u2019s nothing more frustrating than a denied claim. The work was done but, through some technicality or minor coding error, the payer refuses to pay. Practices must resubmit their claims with the hope that they corrected the problem and can now get the money they are owed. Even if [&hellip;]<\/p>\n","protected":false},"author":1,"featured_media":32787,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[4],"tags":[38,39],"class_list":["post-366","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-revenue","tag-icd-10","tag-revenue"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.4 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Denial Management: How to Improve the Process - Continuum<\/title>\n<meta name=\"description\" content=\"The best thing practices can do for their bottom line is to improve denial management and submit cleaner claims from the start. Read more.\" \/>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/carecloud.com\/continuum\/denial-management-how-to-improve-the-process\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Denial Management: How to Improve the Process - Continuum\" \/>\n<meta property=\"og:description\" content=\"The best thing practices can do for their bottom line is to improve denial management and submit cleaner claims from the start. Read more.\" \/>\n<meta property=\"og:url\" content=\"https:\/\/carecloud.com\/continuum\/denial-management-how-to-improve-the-process\/\" \/>\n<meta property=\"og:site_name\" content=\"Continuum\" \/>\n<meta property=\"article:published_time\" content=\"2011-05-25T18:45:10+00:00\" \/>\n<meta property=\"og:image\" content=\"https:\/\/carecloud.com\/continuum\/wp-content\/uploads\/2015\/10\/dummy-2-paigl6zusafxfmk55j3mhrce0nfw5zrnw9chmopqcs.png\" \/>\n\t<meta property=\"og:image:width\" content=\"400\" \/>\n\t<meta property=\"og:image:height\" content=\"350\" \/>\n\t<meta property=\"og:image:type\" content=\"image\/png\" \/>\n<meta name=\"author\" content=\"cc_continuum\" \/>\n<meta name=\"twitter:card\" content=\"summary_large_image\" \/>\n<meta name=\"twitter:label1\" content=\"Written by\" \/>\n\t<meta name=\"twitter:data1\" content=\"cc_continuum\" \/>\n\t<meta name=\"twitter:label2\" content=\"Est. reading time\" \/>\n\t<meta name=\"twitter:data2\" content=\"2 minutes\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\\\/\\\/schema.org\",\"@graph\":[{\"@type\":\"Article\",\"@id\":\"https:\\\/\\\/carecloud.com\\\/continuum\\\/denial-management-how-to-improve-the-process\\\/#article\",\"isPartOf\":{\"@id\":\"https:\\\/\\\/carecloud.com\\\/continuum\\\/denial-management-how-to-improve-the-process\\\/\"},\"author\":{\"name\":\"cc_continuum\",\"@id\":\"https:\\\/\\\/carecloud.com\\\/continuum\\\/#\\\/schema\\\/person\\\/6af17e75a684cc5cd23741e014351348\"},\"headline\":\"Denial Management: How to Improve the Process\",\"datePublished\":\"2011-05-25T18:45:10+00:00\",\"mainEntityOfPage\":{\"@id\":\"https:\\\/\\\/carecloud.com\\\/continuum\\\/denial-management-how-to-improve-the-process\\\/\"},\"wordCount\":505,\"commentCount\":0,\"publisher\":{\"@id\":\"https:\\\/\\\/carecloud.com\\\/continuum\\\/#organization\"},\"image\":{\"@id\":\"https:\\\/\\\/carecloud.com\\\/continuum\\\/denial-management-how-to-improve-the-process\\\/#primaryimage\"},\"thumbnailUrl\":\"https:\\\/\\\/carecloud.com\\\/continuum\\\/wp-content\\\/uploads\\\/2015\\\/10\\\/dummy-2-paigl6zusafxfmk55j3mhrce0nfw5zrnw9chmopqcs.png\",\"keywords\":[\"ICD-10\",\"revenue\"],\"articleSection\":[\"Revenue\"],\"inLanguage\":\"en-US\",\"potentialAction\":[{\"@type\":\"CommentAction\",\"name\":\"Comment\",\"target\":[\"https:\\\/\\\/carecloud.com\\\/continuum\\\/denial-management-how-to-improve-the-process\\\/#respond\"]}]},{\"@type\":\"WebPage\",\"@id\":\"https:\\\/\\\/carecloud.com\\\/continuum\\\/denial-management-how-to-improve-the-process\\\/\",\"url\":\"https:\\\/\\\/carecloud.com\\\/continuum\\\/denial-management-how-to-improve-the-process\\\/\",\"name\":\"Denial Management: How to Improve the Process - Continuum\",\"isPartOf\":{\"@id\":\"https:\\\/\\\/carecloud.com\\\/continuum\\\/#website\"},\"primaryImageOfPage\":{\"@id\":\"https:\\\/\\\/carecloud.com\\\/continuum\\\/denial-management-how-to-improve-the-process\\\/#primaryimage\"},\"image\":{\"@id\":\"https:\\\/\\\/carecloud.com\\\/continuum\\\/denial-management-how-to-improve-the-process\\\/#primaryimage\"},\"thumbnailUrl\":\"https:\\\/\\\/carecloud.com\\\/continuum\\\/wp-content\\\/uploads\\\/2015\\\/10\\\/dummy-2-paigl6zusafxfmk55j3mhrce0nfw5zrnw9chmopqcs.png\",\"datePublished\":\"2011-05-25T18:45:10+00:00\",\"description\":\"The best thing practices can do for their bottom line is to improve denial management and submit cleaner claims from the start. Read more.\",\"breadcrumb\":{\"@id\":\"https:\\\/\\\/carecloud.com\\\/continuum\\\/denial-management-how-to-improve-the-process\\\/#breadcrumb\"},\"inLanguage\":\"en-US\",\"potentialAction\":[{\"@type\":\"ReadAction\",\"target\":[\"https:\\\/\\\/carecloud.com\\\/continuum\\\/denial-management-how-to-improve-the-process\\\/\"]}]},{\"@type\":\"ImageObject\",\"inLanguage\":\"en-US\",\"@id\":\"https:\\\/\\\/carecloud.com\\\/continuum\\\/denial-management-how-to-improve-the-process\\\/#primaryimage\",\"url\":\"https:\\\/\\\/carecloud.com\\\/continuum\\\/wp-content\\\/uploads\\\/2015\\\/10\\\/dummy-2-paigl6zusafxfmk55j3mhrce0nfw5zrnw9chmopqcs.png\",\"contentUrl\":\"https:\\\/\\\/carecloud.com\\\/continuum\\\/wp-content\\\/uploads\\\/2015\\\/10\\\/dummy-2-paigl6zusafxfmk55j3mhrce0nfw5zrnw9chmopqcs.png\",\"width\":400,\"height\":350},{\"@type\":\"BreadcrumbList\",\"@id\":\"https:\\\/\\\/carecloud.com\\\/continuum\\\/denial-management-how-to-improve-the-process\\\/#breadcrumb\",\"itemListElement\":[{\"@type\":\"ListItem\",\"position\":1,\"name\":\"Home\",\"item\":\"https:\\\/\\\/carecloud.com\\\/continuum\\\/\"},{\"@type\":\"ListItem\",\"position\":2,\"name\":\"Denial Management: How to Improve the Process\"}]},{\"@type\":\"WebSite\",\"@id\":\"https:\\\/\\\/carecloud.com\\\/continuum\\\/#website\",\"url\":\"https:\\\/\\\/carecloud.com\\\/continuum\\\/\",\"name\":\"Continuum\",\"description\":\"\",\"publisher\":{\"@id\":\"https:\\\/\\\/carecloud.com\\\/continuum\\\/#organization\"},\"potentialAction\":[{\"@type\":\"SearchAction\",\"target\":{\"@type\":\"EntryPoint\",\"urlTemplate\":\"https:\\\/\\\/carecloud.com\\\/continuum\\\/?s={search_term_string}\"},\"query-input\":{\"@type\":\"PropertyValueSpecification\",\"valueRequired\":true,\"valueName\":\"search_term_string\"}}],\"inLanguage\":\"en-US\"},{\"@type\":\"Organization\",\"@id\":\"https:\\\/\\\/carecloud.com\\\/continuum\\\/#organization\",\"name\":\"Continuum\",\"url\":\"https:\\\/\\\/carecloud.com\\\/continuum\\\/\",\"logo\":{\"@type\":\"ImageObject\",\"inLanguage\":\"en-US\",\"@id\":\"https:\\\/\\\/carecloud.com\\\/continuum\\\/#\\\/schema\\\/logo\\\/image\\\/\",\"url\":\"https:\\\/\\\/carecloud.com\\\/continuum\\\/wp-content\\\/uploads\\\/2025\\\/03\\\/cc-logo-header-2021-1-2.png\",\"contentUrl\":\"https:\\\/\\\/carecloud.com\\\/continuum\\\/wp-content\\\/uploads\\\/2025\\\/03\\\/cc-logo-header-2021-1-2.png\",\"width\":218,\"height\":57,\"caption\":\"Continuum\"},\"image\":{\"@id\":\"https:\\\/\\\/carecloud.com\\\/continuum\\\/#\\\/schema\\\/logo\\\/image\\\/\"}},{\"@type\":\"Person\",\"@id\":\"https:\\\/\\\/carecloud.com\\\/continuum\\\/#\\\/schema\\\/person\\\/6af17e75a684cc5cd23741e014351348\",\"name\":\"cc_continuum\",\"image\":{\"@type\":\"ImageObject\",\"inLanguage\":\"en-US\",\"@id\":\"https:\\\/\\\/secure.gravatar.com\\\/avatar\\\/8b6d796be6337a9688b6e065532f1be27bf69a98f06ddc7a6dda2c9cbbcf4078?s=96&d=mm&r=g\",\"url\":\"https:\\\/\\\/secure.gravatar.com\\\/avatar\\\/8b6d796be6337a9688b6e065532f1be27bf69a98f06ddc7a6dda2c9cbbcf4078?s=96&d=mm&r=g\",\"contentUrl\":\"https:\\\/\\\/secure.gravatar.com\\\/avatar\\\/8b6d796be6337a9688b6e065532f1be27bf69a98f06ddc7a6dda2c9cbbcf4078?s=96&d=mm&r=g\",\"caption\":\"cc_continuum\"},\"sameAs\":[\"https:\\\/\\\/carecloud.com\\\/continuum\"]}]}<\/script>\n<!-- \/ Yoast SEO plugin. -->","yoast_head_json":{"title":"Denial Management: How to Improve the Process - Continuum","description":"The best thing practices can do for their bottom line is to improve denial management and submit cleaner claims from the start. Read more.","robots":{"index":"index","follow":"follow","max-snippet":"max-snippet:-1","max-image-preview":"max-image-preview:large","max-video-preview":"max-video-preview:-1"},"canonical":"https:\/\/carecloud.com\/continuum\/denial-management-how-to-improve-the-process\/","og_locale":"en_US","og_type":"article","og_title":"Denial Management: How to Improve the Process - Continuum","og_description":"The best thing practices can do for their bottom line is to improve denial management and submit cleaner claims from the start. Read more.","og_url":"https:\/\/carecloud.com\/continuum\/denial-management-how-to-improve-the-process\/","og_site_name":"Continuum","article_published_time":"2011-05-25T18:45:10+00:00","og_image":[{"width":400,"height":350,"url":"https:\/\/carecloud.com\/continuum\/wp-content\/uploads\/2015\/10\/dummy-2-paigl6zusafxfmk55j3mhrce0nfw5zrnw9chmopqcs.png","type":"image\/png"}],"author":"cc_continuum","twitter_card":"summary_large_image","twitter_misc":{"Written by":"cc_continuum","Est. reading time":"2 minutes"},"schema":{"@context":"https:\/\/schema.org","@graph":[{"@type":"Article","@id":"https:\/\/carecloud.com\/continuum\/denial-management-how-to-improve-the-process\/#article","isPartOf":{"@id":"https:\/\/carecloud.com\/continuum\/denial-management-how-to-improve-the-process\/"},"author":{"name":"cc_continuum","@id":"https:\/\/carecloud.com\/continuum\/#\/schema\/person\/6af17e75a684cc5cd23741e014351348"},"headline":"Denial Management: How to Improve the Process","datePublished":"2011-05-25T18:45:10+00:00","mainEntityOfPage":{"@id":"https:\/\/carecloud.com\/continuum\/denial-management-how-to-improve-the-process\/"},"wordCount":505,"commentCount":0,"publisher":{"@id":"https:\/\/carecloud.com\/continuum\/#organization"},"image":{"@id":"https:\/\/carecloud.com\/continuum\/denial-management-how-to-improve-the-process\/#primaryimage"},"thumbnailUrl":"https:\/\/carecloud.com\/continuum\/wp-content\/uploads\/2015\/10\/dummy-2-paigl6zusafxfmk55j3mhrce0nfw5zrnw9chmopqcs.png","keywords":["ICD-10","revenue"],"articleSection":["Revenue"],"inLanguage":"en-US","potentialAction":[{"@type":"CommentAction","name":"Comment","target":["https:\/\/carecloud.com\/continuum\/denial-management-how-to-improve-the-process\/#respond"]}]},{"@type":"WebPage","@id":"https:\/\/carecloud.com\/continuum\/denial-management-how-to-improve-the-process\/","url":"https:\/\/carecloud.com\/continuum\/denial-management-how-to-improve-the-process\/","name":"Denial Management: How to Improve the Process - Continuum","isPartOf":{"@id":"https:\/\/carecloud.com\/continuum\/#website"},"primaryImageOfPage":{"@id":"https:\/\/carecloud.com\/continuum\/denial-management-how-to-improve-the-process\/#primaryimage"},"image":{"@id":"https:\/\/carecloud.com\/continuum\/denial-management-how-to-improve-the-process\/#primaryimage"},"thumbnailUrl":"https:\/\/carecloud.com\/continuum\/wp-content\/uploads\/2015\/10\/dummy-2-paigl6zusafxfmk55j3mhrce0nfw5zrnw9chmopqcs.png","datePublished":"2011-05-25T18:45:10+00:00","description":"The best thing practices can do for their bottom line is to improve denial management and submit cleaner claims from the start. Read more.","breadcrumb":{"@id":"https:\/\/carecloud.com\/continuum\/denial-management-how-to-improve-the-process\/#breadcrumb"},"inLanguage":"en-US","potentialAction":[{"@type":"ReadAction","target":["https:\/\/carecloud.com\/continuum\/denial-management-how-to-improve-the-process\/"]}]},{"@type":"ImageObject","inLanguage":"en-US","@id":"https:\/\/carecloud.com\/continuum\/denial-management-how-to-improve-the-process\/#primaryimage","url":"https:\/\/carecloud.com\/continuum\/wp-content\/uploads\/2015\/10\/dummy-2-paigl6zusafxfmk55j3mhrce0nfw5zrnw9chmopqcs.png","contentUrl":"https:\/\/carecloud.com\/continuum\/wp-content\/uploads\/2015\/10\/dummy-2-paigl6zusafxfmk55j3mhrce0nfw5zrnw9chmopqcs.png","width":400,"height":350},{"@type":"BreadcrumbList","@id":"https:\/\/carecloud.com\/continuum\/denial-management-how-to-improve-the-process\/#breadcrumb","itemListElement":[{"@type":"ListItem","position":1,"name":"Home","item":"https:\/\/carecloud.com\/continuum\/"},{"@type":"ListItem","position":2,"name":"Denial Management: How to Improve the Process"}]},{"@type":"WebSite","@id":"https:\/\/carecloud.com\/continuum\/#website","url":"https:\/\/carecloud.com\/continuum\/","name":"Continuum","description":"","publisher":{"@id":"https:\/\/carecloud.com\/continuum\/#organization"},"potentialAction":[{"@type":"SearchAction","target":{"@type":"EntryPoint","urlTemplate":"https:\/\/carecloud.com\/continuum\/?s={search_term_string}"},"query-input":{"@type":"PropertyValueSpecification","valueRequired":true,"valueName":"search_term_string"}}],"inLanguage":"en-US"},{"@type":"Organization","@id":"https:\/\/carecloud.com\/continuum\/#organization","name":"Continuum","url":"https:\/\/carecloud.com\/continuum\/","logo":{"@type":"ImageObject","inLanguage":"en-US","@id":"https:\/\/carecloud.com\/continuum\/#\/schema\/logo\/image\/","url":"https:\/\/carecloud.com\/continuum\/wp-content\/uploads\/2025\/03\/cc-logo-header-2021-1-2.png","contentUrl":"https:\/\/carecloud.com\/continuum\/wp-content\/uploads\/2025\/03\/cc-logo-header-2021-1-2.png","width":218,"height":57,"caption":"Continuum"},"image":{"@id":"https:\/\/carecloud.com\/continuum\/#\/schema\/logo\/image\/"}},{"@type":"Person","@id":"https:\/\/carecloud.com\/continuum\/#\/schema\/person\/6af17e75a684cc5cd23741e014351348","name":"cc_continuum","image":{"@type":"ImageObject","inLanguage":"en-US","@id":"https:\/\/secure.gravatar.com\/avatar\/8b6d796be6337a9688b6e065532f1be27bf69a98f06ddc7a6dda2c9cbbcf4078?s=96&d=mm&r=g","url":"https:\/\/secure.gravatar.com\/avatar\/8b6d796be6337a9688b6e065532f1be27bf69a98f06ddc7a6dda2c9cbbcf4078?s=96&d=mm&r=g","contentUrl":"https:\/\/secure.gravatar.com\/avatar\/8b6d796be6337a9688b6e065532f1be27bf69a98f06ddc7a6dda2c9cbbcf4078?s=96&d=mm&r=g","caption":"cc_continuum"},"sameAs":["https:\/\/carecloud.com\/continuum"]}]}},"_links":{"self":[{"href":"https:\/\/carecloud.com\/continuum\/wp-json\/wp\/v2\/posts\/366","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/carecloud.com\/continuum\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/carecloud.com\/continuum\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/carecloud.com\/continuum\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/carecloud.com\/continuum\/wp-json\/wp\/v2\/comments?post=366"}],"version-history":[{"count":0,"href":"https:\/\/carecloud.com\/continuum\/wp-json\/wp\/v2\/posts\/366\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/carecloud.com\/continuum\/wp-json\/wp\/v2\/media\/32787"}],"wp:attachment":[{"href":"https:\/\/carecloud.com\/continuum\/wp-json\/wp\/v2\/media?parent=366"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/carecloud.com\/continuum\/wp-json\/wp\/v2\/categories?post=366"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/carecloud.com\/continuum\/wp-json\/wp\/v2\/tags?post=366"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}