EHR Tools for Denial Management: Strategies for Resolution

A Survey Revealed that over 10 – 17% of total medical claims have been denied daily. Other healthcare practices in the US show that over 15% of medical claims were denied. The denial rate of medical claims varies among healthcare organizations.

One common challenge that many healthcare practices face is dealing with claims denials from medical insurance companies.

This medical claim denial ultimately leads to delays in payment and affects healthcare practice.

If healthcare practice manages medical claim denial management effectively, a healthcare practice can significantly improve the revenue.

In this blog post, we’ll go through How EHR tools can be utilized for denial management. We’ve also shared some strategies to resolve the claim denial issue promptly.

Understanding the Cause of Medical Denials

Before going through the strategies for effective denial management, let’s understand the basics of the cause of medical denial. 

A Medical Claim Denial occurs when a medical insurance company refuses to pay for the medical service. This denial may be caused by various reasons like;

• Incorrect or Missing Information.
• Non-covered services.
• Delay in informing the Insurer.
• Documentation Mistakes.
• Duplicate Billing.

And other reasons.

Dealing with medical claims denials can be a headache for healthcare practices, but EHR tools simplify the process.

Related: How To Handle Medical Billing Claim Denials With Ease?

Strategies for Medical Claim Denial Management with EHR Tools

Here are the strategies you, as a healthcare practice, must follow to avoid medical claim denials using the EHR tool;

Documentation

One of the most common causes of medical claim denial is missing or incomplete documentation. 

With the help of EHR tools, healthcare practice can ensure that all the necessary is accurately recorded without any mistakes.

Simple prompts and reminders in EHR tools help healthcare staff input all the necessary information and details, reducing the chance of documentation-related claim denials.

Real-Time Eligibility Check

Another cause of claim denial is the patient’s expired insurance coverage. 

Imagine healthcare providers submitting medical claims and finding out that the patient’s medical insurance has expired.

EHR tools help healthcare providers prevent such scenarios by offering real-time eligibility checks. 

Healthcare providers can instantly check a patient’s eligibility by verifying their insurance information instantly.

This will reduce the medical claim denial due to coverage issues.

Automated Claim Scrubbing

Claim scrubbing is the crucial process of checking for any potential claim errors before submitting it to the medical insurance company.

EHR tools are equipped with an automated claim scrubbing feature that identifies any potential errors, allowing the providers to address them before sending them to the insurance company.

This feature significantly reduces the chances of claim denial.

Access to Patient’s Historical Data

Sometimes, medical claims are denied due to the patient’s medical history discrepancies. 

With the help of EHR tools, healthcare providers have complete access to a patient’s medical history data to review past treatments and procedures.

This ensures that the current claim aligns with the patient’s medical history, reducing the claim denial due to discrepancies.

Promptly Resolved Claim Denied

Even though healthcare practices follow the best strategies to resolve claim denials, denials may occur.

The key to efficiently resolving claim denials is to address them promptly. EHR tools often include built-in workflow for managing and avoiding claim denials.

This workflow guides staff through the resolution process, ensuring the necessary steps are taken promptly to appeal the denial or correct any errors.

Utilizing Reporting and Analytics

EHR tools offer robust reporting and analytics capabilities that can be harnessed for denial management. 

Providers can generate reports to identify potential patterns of claim denial, helping them to have a clear understanding of recurring claim denial issues.

With the help of this information, healthcare providers can implement strategies to find the root cause of claim denials and rectify them in the future.

Related: Importance of Medical Coding: A Must-Know One

Vozo’s EHR Solution for Efficient Claim Denial Management

Though EHR tools help during medical claim denial, choosing the right EHR system that resonates with your healthcare practice and efficient claim denial management is necessary.

If you are searching for the best EHR system, Vozo offers a reliable solution. With a vast range of benefits for healthcare providers such as;

• Streamlining documentation workflow.
• Conduct real-time eligibility checks.
• Provide easy access to the patient’s medical records.
• Real-time Eligibility for Patient Insurance
• Accurate reporting and analytics

to efficiently manage the claim denial. Vozo’s EHR system is affordable and your trusted partner in healthcare solutions. 

“Embrace Vozo All-in-one EHR Solution to Reduce Your Burdens and Enhance Patient Care”