Denials Management

Contest medical necessity and clinical validation (DRG) denials.

Why Brundage Group

Payor denials are increasing at an alarming rate and hospitals must be proactive in securing denials management support. Our organization has extensive subject matter expertise in denial resolution to ensure accurate reimbursement.

When claims are denied, timing is critical to determine whether there is merit for an appeal. With a focus on effective overturn rate, our physician advisors help hospitals quickly and effectively determine which cases to review, when to review the cases, and when to appeal.

Denial Analysis and Resolution

Our skilled team of physician advisors and denial management experts takes a meticulous approach to denial analysis and resolution. We understand that behind every denied claim lies a complex web of medical necessity requirements, contractual obligations, and payor tactics. We identify denial trends and root causes through in-depth analysis, allowing us to develop targeted strategies to prevent future denials. We are dedicated to overturning unjust denials and ensuring hospitals receive the accurate reimbursement they deserve.

Peer-to-Peer Support

At Brundage Group, we believe in the power of peer-to-peer collaboration. Our physician advisors have completed thousands of successful peer-to-peer cases, gaining valuable insight into payor tactics and decision-making processes. We leverage this expertise to provide hospitals with robust peer-to-peer support, ensuring their voice is heard by payor medical directors. Through compelling arguments and evidence-based reasoning, we advocate for the medical necessity of procedures, ultimately securing the revenue hospitals have rightfully earned.

Appeals Support

The appeals process can be complex and overwhelming, requiring a thorough understanding of medical necessity and clinical validation denials. Our physician advisors, armed with extensive experience in these areas, provide comprehensive support at all levels of appeal. We go beyond crafting appeal letters; we delve into evidence-based medical literature to substantiate the medical necessity of procedures, reinforcing the credibility of our appeals. From negotiations with Administrative Law Judges (ALJs) to engagements with Independent Review Organizations (IROs), we stand by hospitals every step of the way.

Contract Consultation

Contracts form the foundation of any relationship in healthcare, and understanding their nuances is crucial to mitigate payor tactics and protect hospitals’ interests. Our team of executive physician advisors, with their wealth of contracting experience, provides expert contract consultation services. We meticulously review key contract clauses, identify common pitfalls that are frequently missed, and discuss key contracting strategies with hospitals. By equipping hospitals with the knowledge and insights needed to navigate complex contracts, we ensure they are well-positioned for successful reimbursement while minimizing denials.

What is Denial Management in Healthcare?

Denial Management in healthcare is a crucial aspect of capturing hospital revenue and ensuring the delivery of quality care. At Brundage Group, we understand the profound impact that denials can have on hospitals’ financial health and ability to provide exceptional patient care. Our denial management services are specifically designed to address the challenges hospitals face in the realm of medical necessity denials.

Denial Management involves a proactive approach to identifying, analyzing, and resolving claim denials by payors. These denials can occur for various reasons, including medical necessity, clinical validation, or contractual disputes. Effective denial management is vital to ensure accurate reimbursement and maintain a healthy revenue cycle, ultimately supporting hospitals in their mission to serve the community.

As a trusted partner to hospitals nationwide, Brundage Group has developed a deep understanding of denial management complexities. Our comprehensive Denial Management Services empower hospitals to navigate this intricate landscape confidently while maximizing revenue recovery and upholding the quality care they provide.

Our Denial Management Service Offering

At Brundage Group, we offer a comprehensive range of Denial Management Services tailored to meet the specific needs of our hospital clients. Our clinical expertise and experience enable us to provide effective solutions that streamline the appeals process, optimize overturn rates, and secure earned revenue.

Frequently Asked Questions

How can denial management services benefit hospitals?

Our denial management services assist hospitals in contesting medical necessity denials, improving overturn rates, and securing accurate reimbursement. By leveraging our expertise, hospitals can streamline the appeals process, optimize revenue recovery, and mitigate future denials.

How do you determine the appeal merit of a denied claim?

Our skilled physician advisors and denial management experts carefully review the denied claim, considering medical necessity, clinical validation, and contractual obligations. We evaluate the available evidence, consult evidence-based medical literature, and determine the strength of the case for an appeal.

What types of denials do you specialize in?

We specialize in medical necessity denials and clinical validation denials. Our team of physician advisors and denial management experts has extensive experience in these areas, enabling us to contest denials and secure earned revenue effectively.

Can you help with contract negotiations?

Absolutely. Our team, including executive physician advisors with contracting expertise, provides contract consultation services. We review key contract clauses, identify pitfalls, and discuss strategies to optimize contract negotiations, protecting hospitals’ interests and minimizing denials.

How can Brundage Group help improve patient satisfaction?

Brundage Group’s denial management services play a significant role in improving patient satisfaction indirectly. Hospitals can allocate resources more efficiently and invest in enhancing patient care and experience by effectively managing denials and maximizing revenue recovery.

With accurate reimbursement, hospitals can invest in advanced medical technologies, staff training, and patient-centric initiatives that contribute to improved outcomes and a higher quality of care. Ultimately, the positive impact on patient satisfaction stems from the ability to provide comprehensive, timely, and personalized care that meets and exceeds patient expectations.

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