Outsourced Denial Management
The CMI Group is a best-in-class provider of outsourced denial management for hospitals, health systems, clinics, and private practices. It can be easy for a billing office to get lost or overwhelmed with third-party payers' claims submission and appeals process. An outsourcing partner can help you stay on top of your denials and secure reimbursement. The CMI Group provides a complete denial management solution that works with your existing system to appeal denials, identify root issues, correct processes, and ultimately increase your reimbursement rate.
Claims Management Challenges
Medical insurance claim denials are often the most challenging hurdle for a billing office. Stumbling through appeals leads to increased overhead, loss of revenue, and slow reimbursement. Management of the claims denial process has become quite the burden for many medical business offices to handle on their own due to the following factors:
1. Administrative Complexity
Managing the workflows can be difficult or impossible, with each third-party payer demanding their own unique appeal process unless you have a dedicated team. Also, with the complexity of the appeal process and the negotiating skills required to secure reimbursement, your office needs someone specifically trained as a claims denial specialist.
Recruiting and managing qualified denial specialists can be a serious challenge for the typical medical billing office. Today's job market has gotten very competitive for employers, especially in some geographical regions. Even when you find and hire denial specialists, turnover can drag you back to the starting point.
If administrative complexity or staffing challenges are an issue for your team, it may be time to consider an outsourced solution. Outsourcing claims denial management to a medical BPO company provides multiple valuable advantages, including:
- Relieved administrative burden and more time for other core activities
- Higher reimbursement rates and more revenue
- Faster appeals and cash flow
- Reduced non-compliance risk
- Decreased overhead cost
CMI's Denial Management Solution
At The CMI Group, we recognize the vital significance that claims reimbursement plays in the overall financial strength of your medical center. CMI strives to be a seamless extension of your back-office, and we have a developed an outsourced denial management solution that includes:
1. A Strong Foundation
CMI has access to a deep pool of qualified denial specialists with working experience in medical billing. Building on their existing knowledge and skills, our denial specialists undergo a comprehensive training curriculum upon onboarding, including:
- System(s), configuration, and usage
- Payer-specific claims submission procedures
- Payer-specific appeals procedures
- General medical coding rules
- Local and national coverage determinations for medicare (LCD & NCD)
Additionally, we provide structured continued education to claims specialists as third-party payers update their guidelines.
2. Platform Agnostic
The CMI Group pairs your claims with denial specialists experienced with your particular back-office system. Our solution will work with any billing software that you use. Whether you are using Epic, Cerner, Kareo, McKesson, AdvancedMD, eClinicalWorks, or another EHR system, partnering with CMI will feel like business as usual, but with higher reimbursement rates and less headache.
3. Centralized Operations
Our team specializes in claim denial appeals and leverages streamlined workflows for consistent reimbursement with enhanced efficiency. Our workflows are strengthened by an automated system that reduces manual errors and boosts productivity. We track claims at every stage throughout the process to ensure appeals are filed within a week of denial. If a claim is denied without just cause, our team generates an appeal letter that includes the appropriate documentation. After the appeal letter is submitted, our denial specialists follow up with the payer using the proper mediums such as phone calls, emails, and fax messages.
4. Claims Status Reporting
CMI provides claim status reporting to you and your management team, ensuring you have the visibility and resources to make essential business decisions. As a transparent partner, correspondence with payers is gathered and made available for your viewing.
5. Root Cause Analysis
The CMI Group identifies denial patterns and helps you understand their root causes. We group denials by payer, diagnosis, codes, reasons, and financial impact to help you identify and prioritize areas of concern in your practice or billing office. The root cause analysis provided by CMI ultimately allows you to prevent future denials and increase the speed and value of reimbursement.
6. Process Improvement
The CMI Group is more than just an outsourced vendor; we strive to provide value as a trusted consultant. After the root causes of denial patterns have been identified, our account team can provide actionable solutions for your team's workflows designed to stop denials at the source. Furthermore, CMI has outsourcing options for prior authorization and medical coding that can fill in the gaps when you need an extra hand.
If you need a hand with outsourced denial management, click below to see how CMI can help you increase reimbursement and save money: