What does "denial management" involve in healthcare reimbursement?

Denial management in healthcare reimbursement is a critical process that focuses on reviewing claims that have been denied by payers and identifying the reasons behind those denials. The goal is to secure payment for services rendered by addressing the specific issues that led to the rejection. This involves analyzing denied claims, understanding the payer's criteria for acceptance, and taking corrective actions or submitting appeals when necessary.

Successful denial management can improve a healthcare provider's revenue cycle, mitigate financial losses, and enhance overall operational efficiency. It requires a detailed understanding of coding, billing practices, and payer policies, as well as strong communication skills to effectively negotiate or resolve issues with payers.

While the other options touch on important aspects of healthcare reimbursement, they do not align with the primary focus of denial management. For instance, rejecting patient claims based on eligibility pertains more to initial claim submission rather than the handling of denied cases. Monitoring provider performance metrics relates to quality assurance and operational efficiency, while training staff on billing procedures is about education and prevention rather than managing denied claims. Therefore, reviewing denied claims and securing payment is at the heart of denial management.