A denied claim can be quite frustrating for practices as well as medical billers. If the payer refuses to pay due to minor errors in coding or technicality, practices again have to go through the daunting process of claim re-submission. It costs money to manage the average denial so, even if you manage to collect the payment after re-submission, a significant amount is already lost.
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Denials can either be clinical, underpayments or technical and in order to increase revenue and maintain a constant cash flow, practices need to strengthen denial management and ensure that claims are being submitted without errors. Occurrence and frequency of denials can be reduced by taking the following measures:
- Providers need to identify the type of denial
- Staff needs to be educated on how to submit claims without errors
- A team of certified, well-trained coders and billers needs to be formed
- Training should be provided to the staff for editing claims and preparing appeals
- Providers also need to monitor the progress being made by the billing department
Only when your practice is fulfilling these requirements, number of claim denials can be reduced. Remember, issue of denials can be turned from a liability to an asset through effective denial management.
Majority of denials are caused due to administrative errors that include lack of eligibility verification, inaccuracy of data being entered into the system, lack of authorizations and various other clinical errors. Even inaccurate physician documentation is a major reason for claim denials.
Practices need to form a separate team to collect data related to denials in order to find out the reason behind every payment denial. This data should be reviewed and solutions should be formulated to ensure similar errors don’t take place in the future.
Physicians need to focus on clinical documentation as much as patient care because inaccuracy in documentation can lead to serious errors in coding. Effort must be made to edit claims and staff should be trained for writing and preparing appeals.
It is important to understand that claim denials can be reduced to a great extent with teamwork among coders, billers, practice staff, physicians and revenue cycle managers. So, regular monitoring of any progress in denial management is extremely vital. This will help in taking necessary actions in case of any shortcoming.
Practices lack time and resources for effective denial management:
Many practices opt for assistance from a billing company because handling denial management can be a daunting task considering the lack of time, money and resources. Rather than disrupting the revenue flow of their practice, providers prefer outsourcing the vital tasks related to billing, coding and denial management.
Medicalbillersandcoders.com has been offering effective denial management solutions to practices across the US. We have a team of experts who are trained in maintaining accuracy in coding and billing procedures and ensuring compliance to HIPAA other reforms. With an aim to reduce claim denials and increase revenue, MBC make use of the latest technology to offer the best revenue cycle management services.