Systematic Denial Management

Expert claims denial management can enhance revenue in times of declining payment and increasing cost pressures. Dominion Medical Management knows that the real secret to efficient denial management lies in preventing them by ensuring the accurate claims are submitted the first time.

Coverage Knowledge Center

At the heart of Dominion Medical's PRISM software is the Coverage Knowledge Center which is updated each week with government and health plan reimbursement modifications on a national, state and local basis.  Every line item submitted for reimbursement is electronically checked to ensure the highest levels of reimbursement. 

Of course, some number of claims are still denied. At that point, our PRISM software’s automated denial management follow-up takes over. The system converts all denials, errors, payor rejections, delinquencies and other system actions into follow-up tasks. So all follow-up requirements are on-line and are automatically queued to Account Representatives based on workload and the complexity of the issue.

For those HIPAA Reason and Remark codes that indicate denials, the appropriate charge reference line in the patient account is populated accordingly, and claims are tagged with one of 40 unique internal denial codes and categorized by type: clinical or financial. Clinical denials are routed to the coding staff for adjudication; financial denials are routed to the insurance follow-up department for further processing. All denials are tracked in an electronic follow-up queue to ensure that proper action is taken in a timely manner.

Reporting

Dominion Medical takes a systematic approach to addressing significant denial patterns and payor payment variances within each Client's practice. From a Client perspective, end-of-month reporting summarizes the total dollar amount of denied claims by denial reason. These reports break out denials by reason, payor, location, modality, etc., and highlight potential reimbursement problems. Denial resolution is also reported.