Medical claims denials have become a norm rather than an exception given that insurance payers’ computer software is geared to find the slightest anomaly and use it as a base for rejection. Simple statistics show that only 70% of claims are paid on first submission. Of the remaining, medical practitioners never bother to resubmit in 60% of the cases and fail to collect about 18% of all claims.
Insurance payers reject claims on a number of grounds such as registration inaccuracies, invalid diagnosis code, bundling of charges, no authorization, no referral, ineligibility for insurance, expired insurance, expired credentialing, timeliness and other grounds. The process is automated and computer algorithms blindly match criteria, rejecting a claim in the event of a mismatch.
Each time a claim is rejected it involves considerable labor and time to find out discrepancies, resolve them and resubmit claims. Medical practitioners lack the time and resources to analyze rejections, follow up with patients and resolve issues for successful completion. This results in substantial losses, something you simply cannot afford to ignore. Though it does involve effort and time, a medical practice must devote attention to the process of denial management to mitigate losses.
A good starting point would be to maintain records starting with the number of rejected claims, identifying the reasons and initiating a process to resolve discrepancies, track progress and outcomes. Statistics show that 90% of denials are preventable and 70% are recoverable-
You can easily compile relevant statistics for your practice by totaling claims filed, the dollar value and finding the percentages of passed and denied claims
You can identify the common grounds for denial such as duplicates, ICD-9 and CPT mapping, and take steps to comply
If you had to deal with a single payer, life would be simple but the practice involves dealing with several agencies such as Medicaid, federal cover, Medicare and commercial insurers, each with a different set of rules. Your denial records should show improvements as you track and take action in each case rather than letting it lie
While reviews assist in getting pending issues settled, for the future you would need a claims denial management system that compiles all patient information prior to treatment to make sure denials are at a minimum. The best move is to opt for an expererienced, tested and reliable professional billing service, customized to your specialty. Choosing a billing services which regualry updated with CMS and Medicaid updates is a must, billing specialists also perform regular coding and documentation audits, constantly verify and perfrom regular checks for errors besides tracking policy changes to keep you updated at all times with Medicare, Medicaid, worker compensation and other insurers. While the billing service will take care of compiling your claims with perfect accuracy to minimize rejections on one hand, on the other it will also assist in resubmissions and provide complete analysis for denial management. Hence one little step saves time, efforts and immeasurably increase revenues.
MBC is that wise step which can help you overcome the barriers and discover the primary reason for denials. Medicalbillersandcoders.com can eliminate the problem from the root where we assist in helping you follow proper practice management and also manage the denials in a simple and systematic way. MBC helps you reduce denials probability immediately by bring them to your notice. Our billing experts constantly upodated with industry updates also - analyze payer contracts, update them constantly, check the documentation and codes accurately and take suitable measures to prevent unnecessary denials.