Denial Management
Improving revenue cycle collections thru better handling and response to partial and fully denied claims is often the most critical aspect of RCM practices. This module focuses on bringing this information to in a concise manner, so that you always know what denials you have outstanding.
1: Accessing the Module
You can access this module under the Billing Modules menu using the Denial Management icon.
2: Performing a search
Once inside the module you can search for specific denials that are grouped into Denial Types and subsequent Sub-Categories.
By default, the claim adjustment reason codes (CARC) are categorized into the below Denial Types. You can read more about CARC codes here:
Claim Adjustment Reason Codes | X12
Denial Type | Description |
Billing | Denials related to billing specific issues that often include: timely filing, claim form issues, Missing information/records, amongst other issues. |
Clinical | Denials relating to clinical documentation issues reported by the Payer |
Coding | Denials resulting from issues in the Medical coding such as an invalid diagnosis, modifier, or procedural code |
Posting | These are often non-denial events that are reported similarly to denials where the payer issues an interest payment or the claim wasn't subject to capitation. |
Registration | Denials relating to registration/front-office procedures such as invalid/expired insurance, lack of authorization, missing consent forms, amongst others. |
Note: These groupings can be customized for your server by contacting support.
3: Performing a search
Once inside the module you can search for specific denials that are grouped into Denial Types and subsequent Sub-Categories. You can then make a selection and click on the View Results or if you want to see the CARC information you can click on View All.
This will then populate the module with details and allow you to view specific CARC codes relating to specific accounts. The view is split into two views with View A showing you account level information and View B showing you the CARC codes as they are applied to Billing Codes (CPT/HCPCS) of the account you have selected in View A.
4: Working a Denial
Denials will show active on a particular account until they are acknowledged using one of two methods.
The first method is to leave a folllow-up comment and to select "Mark Denials Resolved?" as checked. This will mark all CARC codes specified for this account to be marked cleared that predate this comment.
If the payer receives a new claim and the adjudication results in the same CARC codes then this claim will appear again inside of this module.
Second, you may use clear denial button in order to manually clear the denials related to a specific claim.
4: Tracking Performance
You can get a quick snapshot of how many denials are outstanding by using the Summary tab which will give you three views of this information.
These are intended to be a quick way to get insights into problem areas that your teams may need to address.
Note: There are also denial related reports available thru Reporting that will show you all denials regardless of whether they have been cleared thru this model or not.
GOREV SUPPORT TEAM
If you have any questions, concerns, or problems regarding this GoRev Tutorial, please contact the GoRev Support Team by submitting an IT Support Ticket, by phone at 1-(317)-794-3900, and/or by email at ask@gorev.com.
Note: If possible, always submit an IT Support Ticket detailing any problem that you are experiencing within GoRev. This will give GoRev Support Agents access to additional information that will help expedite the resolution of your issue. If you are unsure how to submit an IT Support Ticket in GoRev, please see T Support Ticket Creation for assistance.