Denial Management in Medical Coding

1. Denial Management in Medical Coding: Strategies Every Coder Must Know 96000 85521 - 96000 71195 www.miitglobalservices.com

2. Why Denial Management Matters Now More Than Ever Rising Denial Rates Significant Revenue Loss 12% to 15% average private payer denial rates in one year (Optum, 2024). Denials consume up to 5% of net patient revenue, costing hundreds of thousands annually. High Appeal Costs Achievable Reduction Hospitals spent nearly $20 billion in 2022 appealing denied claims (AHA). Effective management can reduce denial rates to the industry benchmark of 5%. 96000 85521 - 96000 71195 www.miitglobalservices.com

3. What Is Denial Management in Medical Coding? • Systematic process of identifying, analyzing, and resolving denied insurance claims. • Involves denial rework (correcting internal errors) and appeals (challenging payer decisions). • Goal: Optimize revenue cycle by improving clean claim submissions and timely reimbursements. • Requires collaboration between coders, billers, and clinical teams. 96000 85521 - 96000 71195 www.miitglobalservices.com

4. Top Reasons Claims Get Denied Coding Errors Documentation Issues Eligibility & Authorization Incorrect or outdated codes (e.g., ICD-11 usage). Incomplete, inaccurate, or missing patient information. Issues with patient eligibility or prior authorizations. Submission Problems Medical Necessity Late or duplicate claim submissions. Services deemed medically unnecessary or non-covered. 96000 85521 - 96000 71195 www.miitglobalservices.com

5. 7 Essential Denial Management Strategies Every Coder Must Know Understand Denial Reasons 1 Analyze denial codes and root causes to target fixes. Maintain Clinical Documentation Integrity 2 Ensure accurate, complete, and specific documentation. Implement a Denial Log 3 Track denials by type, payer, and provider to identify patterns. Streamline Denial Workflow 4 Prioritize high-value claims and automate follow-ups. Submit Timely, Well-Documented Appeals 5 Prepare persuasive appeal letters with supporting evidence. Continuous Staff Training 6 Keep coders updated on coding changes, payer policies, and denial trends. Leverage Technology 7 Use denial management software to automate tracking and reporting. 96000 85521 - 96000 71195 www.miitglobalservices.com

6. Real Impact: How Strong Denial Management Transforms Revenue • Organizations investing in denial management reduce rework costs from $25–$117 per claim. • Proactive handling frees staff to focus on patient care, not paperwork. • Case study: Hospitals cutting denial rates from 15% to 5% saw revenue recovery increase by millions annually. • Improved payer relationships and faster reimbursements enhance financial stability. 96000 85521 - 96000 71195 www.miitglobalservices.com

7. Take Action: Empower Your Coding Team to Win the Denial Battle Invest Wisely Audit & Assess Build Culture Invest in training and technology tailored to your organization’s needs. Start by auditing your current denial rates and reasons today. Foster continuous improvement and collaboration across teams. Remember: Every denied claim is revenue lost—your expertise can reclaim it! 96000 85521 - 96000 71195 www.miitglobalservices.com

8. The healthcare world needs skilled coders now more than ever. For More Details: Official Website: https://miitglobalservices.com/ Instagram: https://www.instagram.com/miit_global_services/ Facebook: https://www.facebook.com/miitglobalservices/ Youtube: http://www.youtube.com/@miitglobalservices4023 96000 85521 - 96000 71195 www.miitglobalservices.com