MedData’s Denials Management Outsourcing Services improves your business office’s effectiveness by allowing it to concentrate on areas of the revenue-generating process that have a higher yield and do not distract hospital account representatives from their primary duties. We have dedicated specialists who focus on denials management nationwide with extensive experience working with ALL payer types, scenarios and denial reasons.
MedData provides invaluable feedback to help the hospital improve its approach to the denial management process. We provide reports on a monthly basis (or as needed) that track payer, denial type, service, and physician’s issues. This helps our clients improve their internal processes that in turn will lead to long-lasting gains in Accounts Receivable performance. MedData works all denial types including:
• Lack of Authorization
• Insufficient Authorization
• Medical Necessity
• Unresponsive Recoupments
• Coverage Exclusions
• Pre-existing Condition
• Coordination of Benefits
• Timely Filing
• Subrogation\Accident Details
• All Denial types (administrative/clinical)
MedData also has a dedicated focus on unresponsive patient denials (UPDs), which consist of any denial type where the patient’s and/or subscriber’s involvement is required in order to secure resolution on the claim. Our service helps prevent these denials from getting lost in self-pay and ending up in bad debt. UPDs include, but are not limited to:
• Coordination of Benefits (COB)
• Pre-existing questionnaires
• Incident letters
• Accident letters
• Adding newborns to policies
• Subrogation forms
• Authorizations
• Any other time a patient’s involvement is required by the insurer
The benefits of utilizing MedData to perform your denials management is that we have the following performance drivers:
• Dedicated RNs on staff for medical necessity reviews, peer to peer coordination, etc.
• Primary focus on Commercial and Medicare/Medicaid claims
• Strategic focus and prioritization based on dollar balance and/or potential reimbursement, age, and timely filing requirements
• OCR capabilities for digitalization of hard copy remits/EOBs
• Dedicated compliance team and internal legal resource with nationwide legal partnerships
• We aggressively work the account until it is 100% resolved
• Complete “feedback loop” to prevent future denials through a rigorous root cause analysis process
• Close coordination with contracting department to ensure compliance and provide insight for future contracting
• Overturn denials through the appeal processes when necessary
• Incoming and outgoing call campaign with the patient
• Patient texting capability
• Streamlined patient letter series
• Skip trace with three levels of escalation
