Practices use denial-management services to handle payment disputes
Physician Practice Advisor, February 21, 2007
Tensions between insurers and physicians about claims payments has spawned a new and growing industry of intermediaries known as denial management, according to a report in the Wall Street Journal.
Examples of denial management services include software systems that help navigate insurers' payment systems and prevent denials, as well as firms that look for unpaid and denied claims. According to a 2004 report by the Center for Information Technology Leadership, payment disputes cost medical providers and insurers about $10 billion annually in unnecessary administrative expenses.
The Wall Street Journal report examined the case of Paluxy Valley Physicians, a Texas-based medical group who, four years ago, was trying to recover more than $500,000 in denied or unpaid claims from insurers. After work with a Boston-based denial-management firm, the group was able to reduce its outstanding claims to $179,000.
