InsightsClaims Adjudication

The Urgency of Prioritizing Denial Management Today

21 Feb, 20235:50 PM

Share this article
Streamline Your Medicare Advantage Operations
Get industry insights, best practices & regulatory updates delivered straight to your inbox.
The Urgency of Prioritizing Denial Management Today

Denial Management is an area that not just needs greater focus but also a more organized and professional approach, now more than ever. Read on to learn about the circumstances that plague the healthcare industry today and how they create an urgent need for a magnifying-glass approach towards identifying and ironing out the faults that cause practices and hospitals to bleed financially.

Like any other business enterprise, healthcare entities also require sound fiscal health to thrive. Well-planned self-improvement initiatives, meticulous programs to enhance the patient experience, and investments in cutting-edge technology and research are all elements that make a healthcare entity a cut above the rest. Unfortunately, the world of healthcare is riddled with external factors that pose a threat to the inflow of cash that can be used to promote these advancements. Some of these factors are as follows:

constraints affecting financial sustainability

1. Process Complexity is Higher Than Ever Before

With insurance companies adding new-fangled clauses into contracts making them even more intricate and difficult to adhere to fully, the percentage of claims denial is on the rise. A majority of claims submitted are usually denied in the first go and require a considerable amount of rework to be sent back and accepted.

key benefits

2. Frequent Changes In Regulations

In the past few years, there has been an onslaught of modifications in mandatory regulations when it comes to the coding and billing part of the claims preparation process. Fledgeling practices and well-established hospitals both have a hard time keeping pace with these frequent legal changes, and this adds to the reason behind the denial of claims.

3. Higher Patient Responsibility

High Deductible health insurance options have gained popularity amongst employers. Such plans hike up the patient’s portion of the overall payment that the provider is entitled to get. Settling bills directly with patients is way more difficult than getting paid directly by a government agency or an insurance provider.

4. Hesitance In Switching to A Denials Management Software

Many healthcare facilities still believe in a manual denial management process. Manual management of denials is quite inefficient in light of all the complications that shroud the claims management process. Switching to a sophisticated automated tool that eliminates errors in the information being submitted as well as takes care of timely submission of claims can bring down the denial rate considerably.

key benefits

Mirra Healthcare, a TPA , instituted by physicians, boasts of experienced, hands-on professionals who have in-depth knowledge in the field of Denial  Management. By getting Mirra onboard as a consulting entity, you can get full-fledged support in redesigning your Denial Management processes so that you are well prepared for handling the external factors that are likely to weaken your practice’s financial condition. You can also opt to outsource your entire Denial Management package to Mirra and entirely focus on patient care without worrying about revenue flow. For more information on how you can partner with Mirra and utilize the services in their Medicare in a Box solution, get in touch with us and book a demo.

Back to topBack to top
Simplify Medicare Advantage with Advanced Solutions
Streamline healthcare ecosystem & enhance patient care with Mirra's Medicare Advantage in a Box.
Boost Revenue with Our
Complimentary CMS Reject Analysis
Leverage our in-depth CMS Reject Analysis to improve claim acceptance rates.

Reviews & Testimonials


NANCY GAREAUCEO of Ultimate Health Plans

"In 2021, Ultimate Health Plans (UHP) partnered with Mirra Health Care (Mirra) to develop a software platform to support processing Claims, Customer Service, Eligibility, Enrollment, Premium Billing, Encounter Processing and a Provider Portal for our Medicare Advantage Plans. Mirra collaborated well with our operations and compliance teams to successfully design and implement a system that was innovative, efficient, and compliant with all Medicare and Florida Medicaid guidelines and requirements all within the scope of our required timeline. We greatly benefitted from the Mirra Project Management Team’s regular communication with Stakeholders through monthly meetings and recurring weekly breakout-focused calls, which were geared towards troubleshooting and goal alignment. Mirra was able to quickly maneuver and adapt their systems to our needs, resulting in successful implementation and go-live. Mirra continues to support our compliant operation and growth in the ever-changing healthcare industry rapidly and effectively updating their systems with new Medicare and Florida Medicaid rates and guidelines to ensure seamless compliance and efficiency. I have absolutely no reservation in recommending their systems to any Payer searching for improvement in their operational efficiency."

Recover Revenues with Our CMS Reject Analysis!

Reach out for a no-obligation consult today.

We respect your privacy and do not sell or share your information with third parties. Please read our privacy policy here.