Denial management is a very important part of healthcare revenue cycle management that can’t be left out. It is beneficial to have a skilled professional, such as an offshore denial management specialist, to ensure claims are processed accurately and efficiently.
Finding the right denial management specialist is more important than ever. We’ll talk about how important it is for healthcare organizations to hire the right specialists for denial management and how that can help them.
A Brief Overview of the Challenges Doctors Face With Medical Insurance Claim Denials
When a medical insurance claim is denied, doctors and other health care providers face a number of problems. These include understanding the insurance company’s policies, the arduous appeals process, the limited options for recourse, the financial impact on practices, and the need to write off denied claims as a loss.
Claim denials can sometimes be caused by simple mistakes or omissions in the process of making a claim. In other instances, denials have more complicated reasons that are hard to appeal to and take a lot of work. They can also cause a lot of money problems for medical practices, especially smaller ones that may not have much money to spend on appeals.
How Virtual Denial Management Specialists Can Help
Virtual denial management specialists play a valuable role in helping doctors and other healthcare providers. They have been trained to understand how complicated the claims process is and can help healthcare professionals deal with the problems that come up when your medical insurance claim is denied.
Working with these specialists can help medical practices identify and appeal denied claims, improve their claims management processes, and increase their reimbursement. They ultimately help ensure that their patients receive the care they need.
What is a Virtual Denial Management Specialist?
A virtual denial management specialist provides guidance in appealing the denied insurance claims remotely. They review the denied claims to identify the root cause so that they can prepare and submit an appeal for the case. They also track its progress and provide regular updates to doctors and patients.
In addition to talking to insurance companies on doctors’ behalf, they can also teach staff how to improve coding or documentation.
What Sets Them Apart From In-House Denial Management Experts?
Virtual denial management specialists and in-house denial management specialists do some of the same things, but there are important differences between the two. These differences include cost, flexibility, expertise, and access to more advanced technology.
In-house specialists are medical practice employees for healthcare providers, and they work on-site to manage denied claims. Meanwhile, virtual denial management specialists are third-party professionals who work remotely in various locations.
It is important to weigh the medical practice needs and available resources to determine if an in-house specialist or a virtual denial management specialist is the best choice for the organization.
Benefits of Hiring a Virtual Denial Management Specialist
Hiring a virtual denial management specialist can help medical practices and other healthcare providers in the following ways:
Reduced Administrative Burden
When healthcare providers hire a virtual denial management specialist, they can free up staff’s time and reduce the administrative burden of managing denials.
Access to Specialized Expertise
Specialists in virtual denial management can help in certain areas of health care, such as radiology or mental health. They can assist in managing complicated claims or a high volume of denials in these fields.
Lower Costs Compared to Hiring In-House Specialists
As third-party professionals, virtual denial management specialists are able to work on a per-project or as-needed basis, which can be a more affordable option than in-house staff.
Increased Efficiency and Productivity
By outsourcing denial management to a virtual assistant, physicians can focus on providing quality patient care, which is what they do best. It helps improve patient satisfaction and overall practice performance.
Factors to Consider When Hiring a Virtual Denial Management Specialist
When considering hiring a virtual denial management specialist, you need to keep in mind several factors, such as:
Healthcare Expertise
Look for a specialist with experience and expertise in your specific healthcare practice. They should have an in-depth understanding of the insurance claim process and know the most common reasons for claim denials.
Good Reputation
A denial management specialist should have a good reputation in the industry. Having positive online reviews is one indicator of this. You can ask for references from other healthcare providers they have previously worked with.
Communication Skills
When working with a virtual medical assistant, they should be easy to reach, quick to respond, and able to talk in clear, short sentences.
Technology Proficiency
Consider what technology tools the specialist uses and if your practice uses them. They should be comfortable using electronic health records (EHR) systems and other relevant software.
Flexibility and Adaptability
Look for a flexible specialist to accommodate your unique needs in your medical practice. They should be able to adjust their services based on your practice size, the type of claims you manage, and the volume of denied claims.
Service Costs
Determine what types of fees the specialist charges and their expected denial management specialist salary. Compare those rates to other similar services in the industry. Also, consider additional costs, such as software fees or communication expenses.
Performance Metrics
Carefully evaluate potential candidates based on their clear metrics for their performance to determine their effectiveness. For example, look for the percentage of claims successfully appealed or the turnaround time for denied claims.
How to Find a Virtual Denial Management Specialist
Finding a virtual denial management specialist needs some research and evaluation. The following tips will help you find the right one:
- Referrals
Reach out to other medical practices, industry associations, healthcare consultants, or healthcare professionals for their recommendations.
- Online Search
Type “virtual denial management specialist” in the search bar of any browser to bring up denial management jobs and a list of specialists offering these services. Review their testimonials and social media profiles to understand their expertise better.
- Professional Organizations
Healthcare Financial Management Association (HFMA) and Medical Group Management Association (MGMA) are among the organizations with directories or resources to find specialists.
- Healthcare Consulting Firms
Phoenix Virtual Solutions is an offshore outsourcing company specializing in revenue cycle management. They offer virtual denial management services and provide recommendations for HIPAA-trained virtual assistants working with them.
- Request for Proposal (RFP)
Consider issuing an RFP to solicit bids from virtual denial management specialists. It outlines the scope of services you need, performance metrics, and other key requirements.
- Proposals and Interviews
Review proposals carefully to evaluate each specialist’s skills and background. Schedule interviews with the most promising candidates to better understand their approach and services.
Why Choose Phoenix Virtual Solutions
Phoenix Virtual Solutions is a leading provider of virtual denial management services. With more than 75 years of experience between them, they help medical practices improve their revenue cycle management and reduce the amount of money lost when claims are denied.
One of the best things about working with Phoenix Virtual Solutions is that they have a team of denial management experts with a lot of experience. They have proven results, advanced technology, transparent reporting, and flexible services customized to your business needs. They develop a tailored solution that fits your budget and requirements.
In addition, Phoenix keeps clients informed about the status of their denied claims and appeals. They resolve your claims as quickly and efficiently as possible.
Final Thoughts
Effective denial management is a crucial component of a successful healthcare practice. Hiring a virtual denial management specialist from a reputable provider like Phoenix Virtual Solutions is a smart move for healthcare providers.
You will receive high-quality denial management services that help maintain financial stability while concentrating on the best patient care. Stay ahead of the curve by contacting Phoenix Virtual Solutions today!
