- Filing claims has become more complicated as health insurers tighten eligibility requirements, and the chances of claims being denied have increased substantially
- Hence when a claim is filed, there is a fair possibility it will be denied and most providers are struggling to balance their busy time schedules to implement additional care while filing claims
Industry Standards say…
|“Average rejected claim rate is reported at 30-33%”|
|According to top ten biller’s investigation on all Healthcare provider’s the claims rejections rate is:
|This rejection rate is observed in Podiatry, Pediatric, Allergy & Asthma, Dental and normally all specialties- if proper EDI or clearing house and payer set-up is not done|
Why do claims get rejected?
Claims may get rejected for just a simple mistake like – Inaccurate coding errors by untrained staff, change of address not supplied to insurer to something complex like – Medical procedure ruled “experimental” and not covered.
Few reasons why claims get denied by insurance carriers:
|Ailment not being covered in the health insurance policy|
|Procedure deemed medically unnecessary|
|Improper claim form filled|
|Claim not filed in time|
|Pre existing disease which was not disclosed|
How does it adversely affect your practice?
As far as possible steer clear of rejected claims as only one rejected claim can put your revenue behind, and bring on additional tasks like:
|Reopening patient’s folder – second review & research of the notes|
|Claims to be compiled again|
|Double checking of codes again to ensure usage of the latest codes|
|Re- submission of claim|
|Insurance carrier may also need to be contacted|
Solution – Reading between the lines to increase your bottom line and revenue!
According to most of the patient-advocacy organizations between 50 – 70% of disputes are resolved through initial appeals made directly to health insurers.
However this could be rather time consuming and opting for outsourcing your medical billing claims to a third party partner could help you get rid of the hassles that a rejected claim can cause.
Achieve the following benefits with MBC:
MBC’s expert Billing & Coding team will be able to efficiently handle your entire billing process, medical being their core process, besides providing updates about new rules and changes for each specialty.
Medicalbillersandcoders.com has been assisting in revenue maximization for healthcare organizations through their revenue management model encompassing: Patient Scheduling and Reminders, Patient enrollment, Insurance Enrollment, Insurance verification, Insurance Authorizations, Coding and audits, Billing and Reconciling of Accounts, Account Analysis and Denial Management, A/R Management, and Financial Management Reporting. All this along with weekly reporting and consultancy ensures our physicians receive the revenue they deserve.