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Rejection and Denial Management (A/R Control)

Eliminate Denials and Rejections. Get paid faster & accurately.

Do you know 30% of your claims get rejected and/or denied?

Every practitioner knows claim rejections and denials can be tricky & complicated. That’s why it is critical that your claims are submitted clean the very first time. Claim denials can simply disrupt your cashflow. Efficient denial management is the key to effective revenue cycle management.

OmniMD RCM is a tool that provides details about every rejection and denial thereby allowing you to address the root cause of your denials and bring down the denial rate. Billers can easily broadly classify and flag denials that require review and efficiently resolve denials and resubmit insurance claims.

Before a claim is channelized into the payer adjudication system, the claim goes through a multistep validation process. With OmniMD RCM at each step, the rejected and denied claims are automatically categorized and put into separate buckets based on clearinghouse and payer status reports, so you don’t have to necessarily login into clearinghouse or payer portals to verify the status every time.

Each validation step reviews the claim for not only EDI file formatting rules but also for patient address, service location, CPT-ICD combination, payer ID, LCD and CCI guidelines, etc.). If there is missing or invalid information, OmniMD RCM will sort those claims into scrub failed bucket and similarly any rejections and denials by clearinghouse or payer into respective buckets based on claim status and remark and rejection codes.

Supported EDI Standards

You can run detailed reports on CARC (Claim Adjustment Reason Codes) and RARC (Remittance Advice Remark Codes) to find the root cause of each denied claim and address the root cause. Preventing and reducing errors in your claims is the key to getting paid faster.

‘Payer Rejected’ and ‘No Payer Response’ Claims

After claims pass through the clearinghouse scrubbing engine, they are ought to be received by payers for adjudication and payment. At this point, these electronic claims pass through another set of validation against payer-specific requirements by payer rule engine and are pushed back specifying the corrections before those claims can be accepted into adjudication system. Also, at times these claims never reach payer adjudication system. Based on time lag through the entire claim submission process, OmniMD provides hot links to classify such claims as ‘Payer Rejected’ and ‘No Payer Response.’

‘Payer Rejected’ and ‘No Payer Response’ Claims

Accounts Receivable Manager (A/R Management)

The claims segregated into rejection and denied buckets can further be categorized and organized into appropriate work queues. You can put each claim into what OmniMD RCM calls as “GAR” or “Group Action Reason” which helps you bunch these claims into either Medicare, Medicaid, or Commercial groups and define an action plan (e.g., claim resubmitted, appeal filed, medical notes requested, CLIA mapping required, send primary insurance EOB, etc.) and state a reason (example, bundled services, claim not on file, capitated, coding error, non-covered service, etc.) as to why such an action plan is required.

Accounts Receivable Manager (A/R Management)

Aging Buckets—All vs Mine, Classification of Aging Tiers

Furthermore, you can classify your claims into folders named ‘high value low aging,’ ‘high value high aging,’ ‘low value low aging,’ and ‘low value high aging’ buckets and even link multiple service dates of same patient with common denial reason or multiple patients with common denials reasons for efficient and effective followup with the payers. The A/R manager provides a comprehensive snapshot to all information you need over phone while addressing denials with insurance company and also ability to capture notes and time these calls for better management of billing resources.

Aging Buckets—All vs Mine, Classification of Aging Tiers

Timely Filing and Appeal Filing Notifications

OmniMD RCM software allows you to set custom configure alerts and notifications based on payer timely filing and appeal filing deadlines – to pinpoint claims that may be stuck in the system. This helps you quickly recognize claims needing your immediate attention to be either corrected and resubmitted and/or send appeals to the payer, minimizing the number of unpaid claims.

Timely Filing and Appeal Filing Notifications

Denial Reporting

An intuitive and powerful denial report groups your denials and rejections by reason, dollar amount, and other trends, so you can quickly and frequently distinguish recurring rejections and denials.

Denial Reporting

Script Manager

Our far-reaching insurance followup module offers ability to write scripts and execute them manually or in an automated way. With script manager, you can not only automate your aging worklists but automate the allocation to you billers to bring on efficiency and effectiveness in your revenue cycle management process. A script filters claims to be followed up and moves claims into automated worklists as specified by GAR (Group/Action/Reason) for your billers automatically, e.g., the script by its own can filter out all Medicare claims that have not been followed up in 15 days (or time specified by you) and allocate all those claims to your dedicated billing staff working on Medicare only. No need for manual assignment of claims to be worked on to your billers. The script manager further allows you to write similar scripts to followup on patient aging not just the insurance aging. You can write multiple scripts and even decide their execution order, both for insurance and patient aging dues.

Script Manager

Appeal and Collection Letters

Our integrated form designer allows you to incorporate and utilize standard appeal and collection letters as well as create custom appeal and collection letters that you can review, modify, print, or electronically fax from the system (with date and time stamp for timely filing appeals).

Appeal and Collection Letters

  • Prevent denials with embedded and user-configured claim validation engine
  • Real-time claim submission status
  • Hot links to identify your lost claims
  • Hot links to identify your no response claims
  • Hot links to identify your rejected and denied/unpaid claims
  • Create transparent to-do lists allowing users to quickly identify claims needing attention
  • Track claim history
  • Script Manager to create automated work queues.
  • Robust reporting to provide insight into your rejections and denials to proactively respond and prevent future denials.
  • Billing Dashboard showing payer denial trends
  • Billing Dashboard showing payment velocity

What Our Clients Say?

“Our practice has been very pleased with the outcomes of your billing and collection services. You have been both informative and patient as we continue to become a more efficient practice. We have recognized that collections have been improved due to your diligence and tenacity.

Thank you for your kindness and hard work.”

Maureen Lacey, Office Manager, Psychiatry Practice

Products And Services

  • EHR
  • Medical Billing Software

“I think this electronic medical record is very good and easy to understand and get the job done. I highly recommend it. The sales and IT support staff and billing support staff are phenomenal. Any electronic medical record that you choose is only as good as the support staff to help you navigate and troubleshoot any issues that will arise. This company does a great job of customizing your preferences and making you feel important as a customer. Terrific company.”

Gastroenterology Practice, IL

Products And Services

  • Medical Billing Services
  • EHR
  • Medical Billing Software

“I want to thank you for your wonderful service!  You are very prompt with replies to my questions.  Very prompt with claim submission and follow up.  Friendly when I speak to you on the phone. Overall, excellent experience with OMNI.  We are very pleased with everything you do!

Have a wonderful day!

Abby, Office Manager, Renewed Vitality

Products And Services

  • Medical Billing Services
  • EHR
  • Medical Billing Software

“We have been using OmniMD since 2008. It has been a great tool for our patient care and billing. It's very easy to use and works for all our specialties.”

Multispecialty Practice, NY

Products And Services

  • Medical Billing Services
  • EHR
  • Medical Billing Software

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